Treatment outcomes and comorbidity in HIV-infected IDU

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2 K24 DA 035684-06A1 This is a resubmission of a competing renewal application for a mid-career investigator award in patient- oriented research (K24) for Dr. Gregory Lucas. Dr. Lucas is a Professor of Medicine at Johns Hopkins University. He is medically trained as an infectious diseases specialist and he completed a PhD in clinical investigation at the Bloomberg School of Public Health. For 20 years, his research has had a dual focus: 1) associations of HIV, HCV, and drug use on kidney and cardiovascular disease, and 2) interventions to improve HIV prevention and treatment outcomes among people who inject drugs (PWID) in the US and elsewhere. In the previous funding period, Dr. Lucas made a major commitment to mentoring and leadership, while maintaining a strong track record of research and funding productivity. The objectives of this renewal application are to continue to support a program for mentoring junior investigators and to foster innovative research through interdisciplinary team building. The research strategy presents three active research platforms for engaging trainees in HIV- and PWID-related research. These three Parent Aims outline currently funded work that will serve as the framework for the K24 proposal. Each Parent Aim is linked to a newly proposed Expansion Aim that provides ownership opportunity for a junior researcher. Dr. Lucas is PI of a Baltimore-based cohort study, now in its second funding period, designed to characterize the roles of HIV, HCV, and cocaine use in kidney and cardiovascular disease (Parent Aim 1). This cohort is unique in having over 1200 iohexol glomerular filtration rate (iGFR) measurements in 384 participants, with up to 6 years of follow-up. The linked Expansion Aim 1 proposes to determine factors associated with the accuracy of creatinine- and cystatin C-based estimation of GFR slope in HIV-positive persons. Parent Aim 2 is a cluster- randomized trial evaluating the effectiveness of an integrated care van (ICV) in providing PWID- and HIV- related evidence-based services to PWID in Baltimore. Expansion Aim 2 proposes to assess the feasibility of providing HCV evaluation and treatment on the ICV and to compare strategies of referring community-recruited HCV-infected PWID to the ICV or to a city health department clinic (standard care) in a pilot randomized trial. Parent Aim 3 describes a large and ongoing research portfolio focused on improving HIV prevention and treatment outcomes in key populations in international settings. Expansion Aim 3 proposes to assess respondent-driven sampling as an interventional tool to identify unaware/out-of-care HIV-positive PWID. The outstanding environment and resources for HIV- and drug use-related research at Johns Hopkins are a key backdrop to this proposal. Finally, Dr. Lucas proposes training to support his career development and team building to lead a multidisciplinary research response to the opioid epidemic in the US.