2/3 COMpAAAS Tripartite: ART-CC, KP, and VA

项目总结/摘要 饮酒的HIV+成年人由于HIV感染、合并症（包括丙型肝炎）， 感染），多种药物和相关物质的使用。在这种情况下，酒精的生物医学后果 适度使用也会发生，并且经常不被重视或被错误归因。“联合体，以改善 艾滋病毒/艾滋病、酒精、衰老和多种物质的成果”（COMpAAAS）得到NIH/NIAAA奖的支持 U24 AA 020794在单一样本中研究该问题，退伍军人老龄化队列研究（VACS）（约50，000例HIV+ 美国退伍军人在人口统计学上与约100，000名未感染的对照者相匹配）。VACS将直接雇用 酒精生物标志物（磷脂酰乙醇[PEth]）和经验证的生理虚弱指标（VACS指数）。在 这套三个应用程序，抗逆转录病毒治疗队列协作（ART-CC）和凯撒 永久（KP）团队加入退伍军人医疗保健系统（VA）团队作为COMpAAAS三方：ART-CC， KP和vp。我们的长期目标是为酒精干预的设计和实施提供信息。我们一起 建议研究酒精和相关物质使用对艾滋病毒的生物医学后果， VACS在北美和欧洲多个医疗保健系统的范围和可推广性， 大大增加了样本量和HIV+受试者的多样性。重要的是，COMpAAAS三方还 扩大了未受感染的对照组的样本，如果我们要了解酒精是如何作用的， 对艾滋病毒的生物医学结果有不同的影响。金伯利进程将能够确定人口统计学上匹配的 来自其北方加州地区的未感染的对照。1945-1965年出生的退伍军人的新VA样本 （出生队列）扩大了丙型肝炎感染者（HCV+）和女性对照者的可及性。三方小组 还将参加一项HIV+子研究（n=2250），HIV研究中的药物、酒精和物质使用 （MASH），其中关于潜在不适当药物（PIMS）和酒精生物标志物的新数据， 物质（烟草，大麻，阿片类药物，可卡因和甲基苯丙胺）将被收集。作为牵头研究中心， 对于目标2，金伯利进程将研究酒精和吸烟对艾滋病毒结果、预防保健和医疗保健的影响。 合并症。我们预计，在艾滋病毒阳性者中，危险的酒精使用、酒精使用障碍和 吸烟将对这些结果产生负面影响;这些影响将在HIV+中放大 与未感染的个体相比。最初，分析将使用电子健康记录数据 包括自我报告的酒精和药物使用情况。分析将在最后一年重复进行， 基于MASH结果的自我报告的酒精和物质使用的偏差。与RFA一致，所有 赠款为所有目标提供数据，具有相同的目标和议定书。该应用程序解决了关键 酒精和烟草使用、抗逆转录病毒药物和可能增加死亡率的药物之间的相互作用， 住院、虚弱和对预防性保健产生不利影响。我们预计调查结果可能会导致 创新干预措施的开发，例如将酗酒、吸烟和预防性护理干预措施结合起来。

PROJECT SUMMARY/ABSTRACT HIV+ adults who drink are already physiologically frail due to HIV infection, comorbidity (including hepatitis C infection), polypharmacy and associated substance use. In this setting, biomedical consequences of alcohol use can occur with moderate use and are often unappreciated or misattributed. The “Consortium to improve OutcoMes in HIV/Aids, Alcohol, Aging & multi-Substance” (COMpAAAS) is supported by NIH/NIAAA award U24AA020794 to study this issue in a single sample, the Veterans Aging Cohort Study (VACS) (~50,000 HIV+ US veterans demographically matched to ~100,000 uninfected comparators). VACS will employ a direct alcohol biomarker (Phosphatidyl-ethanol [PEth] and a validated measure of physiologic frailty (VACS Index). In this set of three applications, the Antiretroviral Therapy Cohort Collaboration (ART-CC) and Kaiser Permanente (KP) teams join the Veterans Healthcare System (VA) team as COMpAAAS Tripartite: ART-CC, KP, and VA. Our long term goal is to inform alcohol intervention design and implementation. Together we propose to study biomedical consequences of alcohol and associated substance use in HIV, extending the scope and generalizability of VACS to multiple healthcare systems in North America and Europe and substantially increasing sample size and diversity of HIV+ subjects. Importantly, COMpAAAS Tripartite also expands the sample of uninfected comparators, a critically important group if we are to understand how alcohol differentially affects biomedical outcomes in HIV. KP will be able to identify demographically-matched uninfected comparators from their Northern California region. A new VA sample of veterans born in 1945-1965 (Birth Cohort) expands access to Hepatitis C infected (HCV+) and women comparators. The tripartite group will also participate in an HIV+ substudy (n=2250), The Medications, Alcohol, Substance Use in HIV Study (MASH), in which new data on potentially inappropriate medications (PIMS) and biomarkers for alcohol and substances (tobacco, marijuana, opioids, cocaine, and methamphetamine) will be collected. As the lead site for Aim 2, KP will examine the impact of alcohol and smoking on HIV outcomes, preventive care, and medical comorbidities. We anticipate that among HIV+ individuals, hazardous alcohol use, alcohol use disorders and smoking will negatively impact each of these outcomes; and that these effects will be amplified in HIV+ individuals compared with uninfected individuals. Initially, analyses will use electronic health record data including self-reported alcohol and substance use. Analyses will be repeated in the final year correcting for biases in self-reported alcohol and substance use based upon MASH results. Consistent with the RFA, all grants contribute data for all aims, have identical aims and protocols. This application addresses key interactions between alcohol and tobacco use, antiretrovirals, and medications that may increase mortality, hospitalization, frailty, and adversely impact preventive health care. We anticipate findings may lead to innovative intervention development, such as combined alcohol, smoking and preventive care interventions.