Management of HIV as a Chronic Disease

将艾滋病毒作为一种慢性疾病进行管理

• 批准号: 8273482
• 负责人: DOUGLAS K OWENS
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8273482
• 关键词: Acquired Immunodeficiency Syndrome; Anti-Retroviral Agents; Antiviral Agents; Cardiovascular Diseases; Caring; Chronic Disease; Chronic Kidney Failure; Clinical; Comorbidity; Complex; Cost Effectiveness Analysis; Data; Development; Disease; Disease Resistance; Effectiveness; Exposure to; Generations; Goals; HIV; HIV Seropositivity; Health; Hepatitis C virus; High Prevalence; Hypertension; Individual; Infection; Integrase Inhibitors; Kidney Diseases; Life; Life Expectancy; Modeling; Morbidity - disease rate; Multi-Drug Resistance; Outcome; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Population; Protease Inhibitor; Provider; Publishing; Regimen; Registries; Research; Research Personnel; Risk; Risk Factors; Tenofovir; United States; Veterans; Work; antiretroviral therapy; cardiovascular disorder risk; clinical care; comparative effectiveness; cost; cost effective; cost effectiveness; economic outcome; experience; health economics; inhibitor/antagonist; mathematical model; mortality; patient population; statistics; trend

DESCRIPTION (provided by applicant): The long-term goal of our research is to provide guidance to clinicians as they choose among alternative ART regimens in patients who have HIV and comorbid conditions. We aim to study the comparative effectiveness and cost effectiveness of ART regimens in two populations of high importance in the VA: patients who have HIV and chronic kidney disease (CKD), and patients with HIV and hepatitis C virus (HCV) co-infection. These comorbidities are of special concern of their high prevalence and substantial morbidity and mortality. We also propose to use the VA HIV clinical case registry (CCR) to evaluate utilization, practice patterns and cost-effectiveness of three new classes of HIV antiretroviral agents that have been introduced recently. These agents are highly effective, but expensive, and our work to date indicates that whether they are cost effective depends on how they are used with other antiretroviral agents. Our study has three specific aims: 1. To evaluate the comparative effectiveness and cost effectiveness of treatment for HIV- positive individuals with risk factors chronic kidney disease o established chronic kidney disease. a. We will use the VA HIV Clinical Case Registry (CCR) of more than 55,000 HIV patients to assess whether exposure to specific antiretroviral drugs or regimens is associated with poorer outcomes in patients with risk for kidney disease or established kidney disease. b. We will develop a cost-effectiveness model to evaluate how alternative antiretroviral regimens influence long-term outcomes, including all-cause mortality, HIV-specific morbidity and mortality, morbidity and mortality from CKD with 2. To evaluate health outcomes, costs and comparative effectiveness and cost effectiveness of HIV antiretroviral regimens in HIV-infected individuals co-infected with HCV. As new antiviral agents become available for treatment of HCV, we will also evaluate their cost effectiveness. 3. To evaluate the practice patterns, utilization and cost effectiveness of the use of new antiretroviral - including but not limited to second generation protease inhibitors, integrase inhibitors, and entry inhibitors - in veterans with HIV.

描述（由申请人提供）： 我们研究的长期目标是为临床医生提供指导，因为他们在患有HIV和共病的患者中选择替代ART方案。我们的目的是研究ART方案在VA两个高度重要人群中的比较有效性和成本效益：HIV和慢性肾脏病（CKD）患者，以及HIV和丙型肝炎病毒（HCV）合并感染的患者。这些合并症的高患病率和高发病率和死亡率特别值得关注。我们还建议使用VA HIV临床病例登记（CCR），以评估最近推出的三类新的HIV抗逆转录病毒药物的利用率，实践模式和成本效益。这些药物非常有效，但价格昂贵，我们迄今的工作表明，它们是否具有成本效益取决于它们如何与其他抗逆转录病毒药物一起使用。我们的研究有三个具体目标：1。评价对有慢性肾脏病危险因素的HIV阳性个体和确诊的慢性肾脏病患者进行治疗的相对有效性和成本效益。 a.我们将使用超过55，000名HIV患者的VA HIV临床病例登记（CCR）来评估暴露于特定抗逆转录病毒药物或方案是否与肾脏疾病风险或已确诊肾脏疾病患者的不良结局相关。 B.我们将开发一个成本效益模型，以评估替代抗逆转录病毒治疗方案如何影响长期结局，包括全因死亡率、HIV特异性发病率和死亡率、CKD的发病率和死亡率（2.评价合并HCV感染的HIV感染者的健康结局、成本以及HIV抗逆转录病毒治疗方案的相对有效性和成本效益。随着新的抗病毒药物可用于治疗HCV，我们还将评估其成本效益。3.评估实践模式，使用新的抗逆转录病毒药物的使用和成本效益-包括但不限于第二代蛋白酶抑制剂，整合酶抑制剂，进入抑制剂-在退伍军人与艾滋病毒。