Cardiovascular Disease in South African HIV Patients: Value of Prevention

 描述（由申请人提供）：心血管疾病（CVD），包括卒中和心肌梗死（MI），是南非一种新出现的公共卫生问题。由于高血压和糖尿病等CVD风险因素的发病率不断上升，南非和所有撒哈拉以南非洲地区在未来几十年内可能会经历CVD的急剧增加。如多个美国和欧洲队列所示，HIV感染患者发生卒中和MI的风险特别高，尤其是在成功接受抗逆转录病毒治疗（ART）的情况下。当再加上南非普通人群中CVD的发病率已经增加时，南非的HIV感染患者可能处于CVD的主要风险中。必须开展进一步研究，以评估这一新出现问题的范围，并制定减少相关发病率和死亡率的战略。2015财年NIH艾滋病研究办公室以及世卫组织CVD全球研究优先事项优先议程呼吁对这些公共卫生问题进行进一步调查。通过使用模拟建模来调查南非的CVD和HIV，这项拟议的研究将研究CVD对HIV/AIDS患者的长期影响，其目的如下：1）开发一种新的南非CVD风险和结果的状态转换模型，并预测CVD对普通人群的临床影响。 2)使用新的CVD模型和已建立的HIV模拟模型评估南非CVD和HIV的竞争风险。 3)比较HIV感染患者高血压筛查、治疗和综合护理的临床影响、成本和成本效益。模拟建模方法还将评估公共卫生干预措施改善临床结果的潜力，并提供降低CVD风险的成本效益策略。K 01提案中提出的研究将建立在我之前在临床流行病学和数学建模方面的培训基础上，由Kenneth Freedberg和米尔顿Weinstein博士提供额外的重点指导，以开发CVD风险，结果和干预措施的模拟模型，从而进行成本效益分析。拟议的培训计划和研究经验将为作为一名独立调查员的职业生涯奠定基础，该调查员的重点是撒哈拉以南非洲的心血管疾病和艾滋病毒双重流行病。

 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD), including stroke and myocardial infarction (MI), is an emerging public health concern in South Africa. Because of a rising incidence of CVD risk factors such as hypertension and diabetes, South Africa, and all of sub-Saharan Africa, are likely to experience a dramatic increase in CVD in the coming decades. HIV-infected patients are at a particularly increased risk for stroke and MI, as demonstrated in multiple US and European cohorts, especially in the setting of successful treatment with antiretroviral therapy (ART). When coupled with the already increasing incidence of CVD among the general population in South Africa, HIV- infected patients in South Africa are likely to be at major risk for CVD. Further research is essential to assess the scope of this emerging problem, as well as strategies to reduce associated morbidity and mortality. The NIH Office of AIDS Research for FY 2015, as well as the WHO Priority Agenda for global research priorities in CVD, have called for further investigation of these public health concerns. By using simulation modeling to investigate both CVD and HIV in South Africa, this proposed research will examine the long-term impact of CVD among people living with HIV/AIDS with the following aims: 1) To develop a novel state-transition model of CVD risk and outcomes in South Africa and to project the clinical impact of CVD in the general population. 2) To assess the competing risks of CVD and HIV in South Africa using the novel CVD model with an established HIV simulation model. 3) To compare the clinical impact, costs, and cost-effectiveness of screening, treatment, and integration of care for hypertension in HIV-infected patients. The simulation modeling approach will also assess the potential for public health interventions to improve clinical outcomes and to provide cost-effective strategies to reduce CVD risks. The research proposed in this K01 proposal will build on my previous training in clinical epidemiology and mathematical modeling, with additional focused mentorship by Drs. Kenneth Freedberg and Milton Weinstein, to develop simulation models of CVD risks, outcomes, and interventions that will allow for cost-effectiveness analyses. The proposed training plan and research experience will provide the foundation for a career as an independent investigator focused on the dual epidemic of CVD and HIV in sub-Saharan Africa.