NATURAL HISTORY OF HCV INFECTION IN DRUG USERS

丙型肝炎病毒(丙型肝炎病毒)感染是导致发病率和死亡率的主要原因。在美国所有高危人群中，注射吸毒者的丙型肝炎病毒感染率最高。我们将前瞻性地研究美国所有高危人群中丙型肝炎病毒感染的自然历史。我们将前瞻性地研究HIV感染或有HIV感染风险的一组吸毒者中丙型肝炎病毒感染的自然历史。受试者将从已经参加了一项关于吸毒者艾滋病毒感染自然史的大型纵向研究的参与者中招募。因此，我们将能够利用在该研究中收集的大量和复杂的数据集，我们将能够将收集的关于丙型肝炎病毒感染自然历史的新数据与这些数据联系起来。参与者将接受详细的标准化访谈，内容包括人口统计学、病史、性和吸毒行为、艾滋病毒和免疫学测试以及丙型肝炎病毒感染测试，包括定量丙型肝炎病毒RNA水平，包括定量丙型肝炎病毒RNA水平、丙型肝炎病毒基因分型、抗丙型肝炎病毒抗体，以及部分参与者的丙型肝炎病毒测序。被发现感染丙型肝炎病毒的人将被转介到研究肝病专家那里接受肝脏疾病的评估，并为他们的丙型肝炎病毒感染提供标准的药物治疗。我们的目标是确定1)HIV感染及其相关的免疫缺陷、丙型肝炎病毒基因型和药物使用行为对丙型肝炎病毒载量和肝病进展的影响，2)HIV感染和免疫缺陷对丙型肝炎病毒感染治疗反应的影响，3)高效抗逆转录病毒治疗和控制HIV病毒载量对丙型肝炎病毒感染自然病史的影响，以及4)免疫缺陷是否促进了丙型肝炎病毒的遗传多样性。

Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality. Injection drug users have the highest prevalence of HCV infection among all populations in the U.S. at risk. We will study prospectively the natural history of HCV infection among all populations in the U.S. at risk. We will study prospectively the natural history of HCV infection in a cohort of drug users with or at risk for HIV infection. Subjects will be recruited from among participants already enrolled in a large longitudinal study of the natural history of HIV infection in drug users. We will, therefore, be able to take advantage of the large and complex sets of data being collected in that study, and we will be able to link new data that will be collecting on the natural history of HCV infection with those data. Participants will have detailed standardized interviews on demographics, medical history, sexual and drug use behaviors, HIV and immunological testing, and testing for HCV infection, including quantitative HCV RNA levels, including quantitative HCV RNA levels, HCV genotyping, anti-HCV antibodies and, in a subset of participants, HCV sequencing. Persons found to have HCV infection will be referred to the study hepatologist to be evaluated for liver disease and they will be offered standard medical therapy for their HCV infection. Our aims are to determine 1) the effects of HIV infection and its associated immunodeficiency, HCV genotype, and drug use behaviors on HCV viral load and progression of liver disease, 2) the effects of HIV infection and immunodeficiency on response to therapy for HCV infection, 3) the effects of highly active anti-retroviral therapy and control of HIV viral load on the natural history of HCV infection, and 4) whether genetic diversity of HCV is facilitated by immunodeficiency.