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

摘要 感染艾滋病毒的成年人饮酒，由于艾滋病毒感染，已经在生理上脆弱，科摩罗 （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，生物医学 酒精使用的后果可能发生在较低风险的使用，可能不被重视或错误归因。的 支持“提高艾滋病毒/艾滋病、酒精、衰老和多种物质成果联盟”（COMpAAAS） 美国国立卫生研究院/NIAAA奖U24 AA 020794研究这个问题在一个单一的样本，退伍军人老龄化队列研究 （VACS）。在这三个应用程序中，抗逆转录病毒治疗队列协作（ART-CC）和Kaiser 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干预措施的设计和实施提供信息。我们一起学习 使用酒精和相关物质对艾滋病毒的生物医学后果， VACS从单一国家医疗保健系统到10个北美国家12个系统的可推广性 和欧洲国家，使艾滋病毒阳性样本增加一倍，并大大增加了受试者的多样性。 重要的是，COMpAAAS Tripartite还扩展了未感染的对照组（更多女性，年轻人， 患者和HCV+）可用于分析，如果我们要了解酒精如何区分 影响个体生物医学结果的HIV状态、性别、年龄和HCV状态。使用倾向和 根据每个目标和假设量身定制的相关方法和变量，我们将使艾滋病毒+受试者与 未受感染的比较对象来自370万金伯利进程成员（190万妇女）和500万退伍军人， 1945-1965年（出生队列，包括450，000名HCV+）。ART-CC、KP和VA还将参加一个艾滋病毒+ 子研究（n=2250），HIV研究中的药物、酒精和物质使用（MASH），涉及新的， 关于潜在不适当药物（PIMS）和直接生物标志物测量的前瞻性数据， 酒精和相关物质（烟草、大麻、阿片类药物、可卡因和甲基苯丙胺）。ART-CC， 金伯利进程和弗吉尼亚州有相同的目标和协议，并提供和分享数据。目的是比较艾滋病毒感染者和 未受感染的个人和地址：1）酒精和烟草对所有原因和原因的归因风险 具体的住院和死亡率; 2）酒精和烟草对小学和中学的影响 预防保健; 3）酒精和ART对药物相互作用的作用（可能不适当 药物）导致不良生物医学后果。VA将协调共享有限数据集， 关于艾滋病毒队列数据交换协议，这是数据共享的标准化格式。标准化 将采用数据清理、插补和分析方法。

Abstract HIV infected adults who drink alcohol 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 at lower risk use and may be 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). 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 intervention design and implementation. Together we will study biomedical consequences of alcohol and associated substance use in HIV extending the scope and generalizability of VACS from a single national healthcare system to 12 systems across 10 North American and European countries, doubling the HIV+ sample and substantially increasing the diversity of subjects. Importantly, COMpAAAS Tripartite also extends the pool of uninfected comparators (more women, young patients, and HCV+) available for analyses, a critical step if we are to understand how alcohol differentially affects individual biomedical outcomes by HIV status by gender, age, and HCV status. Using propensity and related methods and variables tailored to each aim and hypothesis, we will closely match HIV+ subjects with uninfected comparators drawing from 3.7 million KP members (1.9 million women) and 5 million veterans born in 1945-1965 (Birth Cohort, includes 450,000 HCV+). ART-CC, KP, and VA will also participate in an HIV+ substudy (n=2250), The Medications, Alcohol, Substance use in HIV Study (MASH), involving new, prospective data on potentially inappropriate medications (PIMS) and direct biomarker measurements for alcohol and associated substances (tobacco, marijuana, opioids, cocaine, and methamphetamine). ART-CC, KP and VA have identical aims and protocols and contribute and share data. Aims compare HIV infected and uninfected individuals and address: 1) attributable risk from alcohol and tobacco for all cause and cause specific hospitalization and mortality; 2) the impact of alcohol and tobacco on primary and secondary preventative care; and 3) the role of alcohol and ART on drug interactions (potentially inappropriate medications) leading to adverse biomedical consequences. VA will coordinate sharing limited data sets based on the HIV Cohorts Data Exchange Protocol (HICDEP) a standardized format for data sharing. Standardized methods for data cleaning, imputation, and analyses will be employed.