North American AIDS Cohorts Collaboration on Research and Design

我们建议建立北美艾滋病队列研究和设计合作组织（NA- 雅阁）对评估艾滋病RFA国际数据库的回应。NA-ACCORD的设计 在美国和加拿大的艾滋病护理中具有广泛的代表性，并且由学术界和 提供艾滋病毒初级和专科护理的医疗中心和社区设施。此外，它 将经典的流行病学和临床HIV队列结合在一起，进行独特而强大的合作，包括 艾滋病毒血清反应阳性和阴性的人。NA-ACCORD由三个主要核心组成- 行政管理、数据管理和流行病学/生物统计学-为高效的 区域数据收集和管理，并进行分析，以回答 重要性对我们的结构至关重要的是研究人员与高水平的科学和 方法学专业知识和艾滋病毒临床经验，以确定区域内和 区域间的重要性，并设计和实施必要的分析，以回答这些问题。我们 核心目标旨在回答我们认为对当代最关键的问题。 在北美治疗HIV感染。北方的艾滋病毒感染者人数很多，而且越来越多， 美国已经接受了多种抗逆转录病毒（ARV）治疗，但没有明显的选择继续下去 因为艾滋病病毒的抗药性。这些患者的最佳管理尚不清楚， 解决这一问题的方法上的重大挑战。抗逆转录病毒药物选择的迅速扩大， 耐受性、毒性和剂量的变化，提出关于何时开始抗逆转录病毒治疗和最佳治疗的问题。 抗逆转录病毒治疗的顺序现在很重要。额外的目标将利用我们合并的大型 样本量和随访持续时间，重点是确定新发HIV的不常见不良事件 长期问题，如恶性肿瘤的发展和衰老对艾滋病毒治疗的影响 响应，开发新的方法，观察艾滋病毒研究和使用我们的组合标本 用于药物遗传学和其他过渡性研究的储存库。恰当地说，我们的目标是最相关的 北美;然而，它们也可以推广到HAART可用的其他地区（即， 西欧），并将为今后在过渡和发展中地区的艾滋病毒防治工作提供信息。

We propose to create the North American AIDS Cohort Collaboration on Research and Design (NA- ACCORD) in response to the International Databases to Evaluate AIDS RFA. The NA-ACCORD is designed to be widely representative of HIV care in the United States and Canada, and is comprised of both academic medical centers and community-based facilities that deliver HIV primary and specialty care. Further, it combines classical epidemiologic and clinical HIV cohorts in a unique and robust collaboration that includes both HIV-seropositive andseronegative persons. The NA-ACCORD consists of three major Cores - Administrative, Data Management, andEpidemiology/Biostatistics - that provide an infrastructure for efficient regional data collection and management, and the conduct of analyses to answer scientific questions of importance. Critical to our structure is the collaboration of investigators with a high level of scientific and methodologic expertise and HIV clinical experience to both identify questions of intraregional and interregional importance, and design and implement the analyses necessary to answer these questions. Our Core Aims are designed to answer questions that we have identified as most critical to the contemporary treatment of HIV-infection in North America. A large and growing number of HIV-infected persons in North America have received multiple antiretroviral (ARV) regimens with few apparent options for continuing treatment because of HIV resistance. The optimal management of these patients is unclear, and there are substantial methodologic challenges in addressing this issue. The rapid expansion of ARV options, with changes in tolerability, toxicity and dosing, make questions about when to begin ARVs and optimal sequencing of ARV therapy important to now address. Additional aims will leverage our combined large sample size and duration of follow-up to focus on identifying uncommon adverse events from new HIV therapies, long-term issues such as development of malignancy and effects of aging on HIV therapeutic response, developing new methods for observational HIV research and using our combined specimen repostitories for pharmacogenetic and other transitional research. Appropriately, our Aims are most relevant to North America; however, they will also be generalizable to other regions where HAART is available (i.e., Western Europe), and will inform future HIV practice as it evolves in transitional and developing regions.