Using the VACS Index to track health outcomes associated with changes in drug use

描述(由申请人提供)：非法药物使用的不利影响既有直接毒性，也有因感染、不遵守医疗方案、营养不良和自我护理受损而产生的间接影响。这些不利影响在艾滋病毒感染者中尤其明显，因为他们的共病和生理脆弱的发病率很高。有效治疗药物使用障碍，减少非法药物使用，可通过减少直接毒性和改善服药依从性、营养和自我护理，以同样不同的方式影响生理。因此，药物治疗的健康益处不是通过非法药物使用的自我报告或尿毒学分析来获得的，可能更好地通过标记物来反映 肝脏、血液学、肾脏和免疫功能。退伍军人老龄化队列指数(VICS)将肝脏(丙型肝炎感染，FIB-4)、肾脏(EGFR)和血液学(血红蛋白、血小板)功能的测量添加到年龄、CD4计数和艾滋病毒病毒载量中，是一个经过验证的生物标记物指数，已被证明反映了艾滋病毒感染患者免疫功能、酒精消费和整体健康的改善。拟议研究的目标是评估Vacs指数作为一个生物标记物，在一系列三个子研究中反映减少物质使用的好处。目的1将在接受阿片激动剂治疗的艾滋病毒感染的阿片依赖患者中进行。使用尿毒学分析评估的非法阿片类药物使用的变化将与Vacs指数的变化相关。目的2将艾滋病毒感染者中自我报告的个别物质(阿片类药物、可卡因、大麻和烟草)的使用情况与Vacs指数的变化相关联，并将吸毒期和戒毒期的Vacs指数结果进行比较。目的3将通过尿毒理学分析，评估接受阿片类激动剂治疗的未感染艾滋病毒的人对阿片类药物使用变化的反应性。这一系列研究是在一大群艾滋病病毒感染者和非艾滋病病毒感染者中进行的，这些病人拥有关于实验室数值、尿毒学测试和药物辅助治疗的广泛数据，这一系列研究将增加我们对Vacs Index所做的广泛验证工作。这项工作有可能提供证据，支持使用这一独特的常用实验室测试集合来监测减少非法药物使用对健康的益处。

DESCRIPTION (provided by applicant): The adverse effects of illicit drug use result from both direct toxicities and indirect effects due to infections, non-adherence to medical regimens, poor nutrition, and impaired self- care. These adverse effects are especially evident in HIV-infected individuals due to their high prevalence of comorbid conditions and physiologic frailty. Effective treatment of substance use disorders leading to reductions in illicit drug use can influence physiology in an equally diverse manner by reducing direct toxicities and improving medication adherence, nutrition and self-care. Therefore the health benefits of drug treatment not captured by self-report of illicit drug use or urine toxicology analyses, may be better reflected by markers of liver, hematologic, kidney, and immune function. The Veterans Aging Cohort (VACS) Index adds measures of liver (hepatitis C infection, FIB- 4), kidney (eGFR), and hematologic (hemoglobin, platelets) function to age, CD4 count and HIV viral load and is a validated biomarker index that has been shown to reflect improvement in immune function, alcohol consumption, and overall health in HIV- infected patients. The goals of the proposed research are to evaluate the VACS Index as a biomarker reflecting the benefits of reductions of substance use in a series of three sub studies. Aim 1 will be conducted in HIV-infected opioid dependent individuals receiving opioid agonist treatment. Changes in illicit opioid use assessed using urine toxicology analyses will be correlated with changes in the VACS Index. Aim 2 will correlate changes in self-reported use of individual substances (opioids, cocaine, marijuana, and tobacco) among HIV-infected subjects, with changes in the VACS Index and compare VACS Index results obtained during periods of drug use, with those obtained during periods of abstinence. Aim 3 will evaluate the responsiveness of a modified VACS Index (removing CD4 count and HIV viral load) to changes in opioid use, assessed using urine toxicology analysis, among HIV-uninfected individuals receiving opioid agonist treatment. This line of research conducted in a large and well characterized cohort of HIV-infected and HIV-uninfected patients with extensive data on laboratory values, urine toxicology tests, and medication-assisted treatment, will add to the extensive validation work we have done with the VACS Index. This work has the potential to provide evidence supporting the use of this unique aggregation of commonly available laboratory tests to monitor the health benefits of reduced illicit drug use.