2/6 COMpAAAS U01: Observation Study

摘要 在接受抗逆转录病毒治疗(ART)的艾滋病毒感染者(HIV+)中，多药联用的比例是接受抗逆转录病毒治疗的患者的三倍 比那些没有感染的人更常见，而且发生得早10年。很可能是因为更多的生理因素 艾滋病毒携带者身体虚弱、服用多种药物(5种以上慢性药物)也与更高的死亡率有关。 潜在不适当药物(PIM)是指那些可能因药物造成的危害大于益处的药物 相互作用和不良反应，这些都会随着多药联用而增加。而65岁以上的PIM的标准 年龄(老龄化的PIM)已经确定，它们还没有在HIV+个体中得到验证。更进一步，艺术 饮酒也会增加PIM。我们不知道哪些非ART药物疗法(联合用药)是 对HIV+饮酒的人有帮助，但实际上是有害的。相反，艾滋病毒和酗酒也可能是一种 获得有用的一氧化碳药物的障碍。在有限的证据面前，提供者可能不愿治疗 出于安全考虑，在HIV+患者中使用药物的酒精使用障碍(AUD)。此外，酒精 使用是丙型肝炎病毒治疗的相对禁忌症。因此，饮酒者可能会选择少报酒精含量 用于获得直接作用代理(DAA)，但可能会受到更大的伤害和更少的好处。我们抽签 关于退伍军人老龄化队列研究中丰富的、纵向的临床数据，并用战略加以加强 额外的数据收集和创新技术，以纠正测量中的系统误差 有迹象表明令人困惑。我们将量化老龄化、ART和酒精PIM以及 AUD和丙型肝炎的药物治疗对患者显著结局(PSO)的影响，包括死亡率、住院时间、 医学上的重大跌倒、细菌性肺炎和精神错乱，以确定药物的优先顺序和限制 多药联用对艾滋病毒感染者的危害。我们的研究是及时的和创新的。综合药房是 正常情况下，澳大利亚正在接受治疗，用于丙型肝炎的DAA直到最近才可用。而其他人则 量化的私营部门会计准则，我们将衡量它们对私营部门会计准则的实际影响。我们还将衡量以下方面的好处 HIV+和未感染饮酒的人中AUD和丙型肝炎的药物治疗。这些研究将是 有助于设计电子健康干预措施，促进个性化护理和简化成本 在HIV+患者中使用药物(见U24s Champ&RIB)。

Summary Among those with HIV infection (HIV+) on antiretroviral therapy (ART), polypharmacy is three times more common than among those without infection and occurs 10 years earlier. Likely due to greater physiologic frailty, polypharmacy (5+ chronic medications) among those with HIV is also associated with greater mortality. Potentially inappropriate medications (PIMs) are those which likely cause more harm than benefit due to drug interactions and adverse reactions and these increase with polypharmacy. While criteria for PIMs among 65+ year olds (Aging PIMs) are established, they have not been validated among HIV+ individuals. Further, ART and alcohol use also increase PIMs. We do not know which non ART pharmacotherapies (co medications) are helpful and which are actually harmful among HIV+ who drink. Conversely, HIV and alcohol use may also be a barrier to receipt of helpful co medications. In the face of limited evidence, providers may be reluctant to treat Alcohol Use Disorder (AUD) with medications among HIV+ individuals due to safety concerns. Further, alcohol use is a relative contraindication for HCV treatment. As a result, drinkers may choose to under report alcohol use to gain access to direct acting agents (DAAs) but may experience more harm and less benefit. We draw on the rich, longitudinal clinical data in the Veterans Aging Cohort Study and enhance it with strategic additional data collection and innovative techniques to correct for systematic error in measurement and confounding by indication. We will quantify the impact of Aging, ART and Alcohol PIMs and of pharmacotherapies for AUD and HCV on patient salient outcomes (PSOs) including mortality, hospitalization, medically significant falls, bacterial pneumonia, and delirium to inform prioritization of medications and limit harm from polypharmacy among HIV+ individuals. Our study is timely and innovative. Polypharmacy is the norm, AUD is under treated, and DAAs for HCV have only recently become available. While others have quantified PIMs, we will measure their actual impact on PSOs. We will also measure the benefit from pharmacotherapy for AUD and HCV among HIV+ and uninfected individuals who drink. These studies will be instrumental in the design of eHealth interventions facilitating personalized care and simplification of co medications among HIV+ individuals (see U24s CHAMP & RIB).