Johns Hopkins HIV Clinical Cohort

约翰霍普金斯大学艾滋病毒临床队列(JHHCC)自1989年以来一直是纵向 HIV感染者的危险因素、治疗和临床转归的研究。巴尔的摩 该区域艾滋病毒感染和药物使用的流行重叠，主要是海洛因和可卡因 使用，我们的大部分研究都集中在这一人群中，其优势是直接比较 与来自相同地理和社会经济背景的未使用人群一起使用药物的人 该地区的集水区。我们的队列主要是非洲裔美国人，其中有很高比例的 在这些往往研究不足的人群中，为了解这些流行病提供了必要的窗口。 高效的抗逆转录病毒疗法(ART)显著提高了存活率； JHHCC队列年龄为54岁，预期寿命为20-30岁。新的联邦倡议已经 &gt；90%的PWH在HIV护理中的目标，以便数据更好地了解和克服挑战 长期的艾滋病毒护理与当前的流行病特别相关。我们目前的目标是建立在 我们在纵向研究方面的优势，专注于长期感染的患者群体 术语艺术。非传染性疾病(NCD)似乎以更高的发病率和更早的速度发生 年龄比预期的要大，即使是那些被病毒抑制的人也是如此。我们和其他人已经证明了 物质使用是实现艾滋病毒护理连续性成果的障碍，并增加了风险 艾滋病毒的共病和死亡率。我们的第一个目标是描述PWH延长的临床病程。 在当代艾滋病毒护理中，评估阿片类药物和其他物质使用的相关性及其 HIV关怀连续疗法对老年HIV感染者非传染性疾病发病率和死亡率的影响。另一个 JHHCC的焦点一直是病毒性肝炎合并感染，特别是丙型肝炎(丙型肝炎)的共病 这在我们40%的患者中很普遍，主要是因为静脉注射尿毒症。尽管我们现在有效地 治疗丙型肝炎病毒，在治愈那些使用药物的人和那些接受治疗的人的肝脏方面仍然存在挑战 纤维化很常见，未来患上肝硬变、脂肪变性和肝癌的风险还不清楚。 再次感染的风险。我们的第二个目标将集中在丙型肝炎病毒的治疗以及这些治疗的比率和风险 接受治疗的患者的不良肝脏结局和再次感染。最后，JHHC有一个 经过验证的高效协作历史，有500多种出版物，其中一半是 多站点协作。这些研究不仅包括观察性研究，还包括对 发病机制、实施科学和临床试验。我们的第三个目标是加强与 将从JHCC的资源中受益的调查人员，特别是作为 创造NIDA机会的队列合作联盟(C3PNO)。

The Johns Hopkins HIV Clinical Cohort (JHHCC) has been a resource since 1989 for longitudinal research on the risk factors, treatment and clinical outcomes of persons with HIV (PWH). The Baltimore region has overlapping epidemics of HIV infection and substance use, predominantly heroin and cocaine use, and much of our research has focused in this population, with the advantage of directly comparing those who use substances with a non-use population from the same geographic and socioeconomic catchment areas of the region. Our cohort is predominantly African-American with a high proportion of women, providing a needed window into these epidemics in these often understudied populations. Highly-effective antiretroviral therapy (ART) has markedly improved survival; the median age of the JHHCC cohort is 54 years with an expected life-expectancy of 20-30 years. New federal initiatives have a goal of >90% of PWH in HIV care, so that data to better understand and overcome the challenges to long-term HIV care are particularly relevant to the contemporary epidemic. Our current Aims build upon our strengths in longitudinal research, focusing on the chronically-infected patient population on long- term ART. Non-communicable diseases (NCD) appear to be occurring at higher rates and at earlier ages than expected, even in those who are virally suppressed. We and others have shown that substance use is a barrier to achieving the outcomes of the HIV Care Continuum, and increases the risk of comorbidity and mortality in HIV. Our first Aim is to characterize the extended clinical course of PWH in contemporary HIV care, evaluating the associations of opioid and other substance use and its treatment with the HIV Care Continuum, NCD morbidity and mortality in those aging with HIV. Another focus of the JHHCC has been viral hepatitis co-infection, particularly hepatitis C (HCV), a comorbidity that is prevalent in 40% of our patients, principally because of IDU. Although we are now effectively treating HCV, challenges remain in curing those who use substances and in those who are treated, liver fibrosis is common and the future risk of cirrhosis, steatosis and hepatic cancer is unclear, as well as the risk of re-infection. Our second Aim will focus on HCV treatment and the rates and risks of these adverse liver outcomes and re-infection in those who have been treated. Finally, the JHHCC has a proven history of highly productive collaboration, with over 500 publications, half of which are with multisite collaborations. These include not only observational research, but translational studies of pathogenesis, implementation science and clinical trials. Our third Aim is to enhance collaboration with investigators who would benefit from the resources of the JHHCC, and especially as part of the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO).