Management of HIV as a Chronic Disease

描述(由申请人提供)： 我们研究的长期目标是为临床医生在感染艾滋病毒和合并疾病的患者选择替代ART方案时提供指导。我们的目标是研究ART方案在退伍军人管理局中两个高度重要的人群中的比较效果和成本效益：艾滋病毒和慢性肾脏疾病(CKD)患者，以及艾滋病毒和丙型肝炎病毒(HCV)混合感染的患者。由于发病率高、发病率和死亡率高，这些合并症特别令人关注。我们还建议使用VA HIV临床病例登记(CCR)来评估最近推出的三类新的HIV抗逆转录病毒药物的使用情况、实践模式和成本效益。这些药物非常有效，但价格昂贵，我们到目前为止的工作表明，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的：1.评估HIV阳性患者合并慢性肾脏疾病或慢性肾脏疾病的危险因素的治疗的比较效果和成本效益。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有肾脏疾病风险或已有肾脏疾病风险的患者预后较差相关。我们将开发一个成本效益模型来评估替代抗逆转录病毒疗法如何影响长期结果，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。评估健康结果、成本以及HIV抗逆转录病毒方案在HIV感染者和丙型肝炎患者中的比较效果和成本效益。随着新的抗病毒药物可用于治疗丙型肝炎病毒，我们也将评估它们的成本效益。3.评估在感染艾滋病毒的退伍军人中使用新的抗逆转录病毒药物--包括但不限于第二代蛋白酶抑制剂、整合酶抑制剂和进入抑制剂--的做法模式、利用率和成本效益。

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.