Using the VACS Index to track health outcomes associated with changes in drug use

描述（由申请人提供）：非法药物使用的不良反应由直接毒性和感染、不依从药物治疗方案、营养不良和自我护理受损引起的间接影响引起。这些不良影响在HIV感染者中尤其明显，因为他们的共病状况和生理虚弱的患病率很高。有效治疗药物使用障碍导致非法药物使用减少，可以通过减少直接毒性和改善药物依从性、营养和自我保健以同样多种方式影响生理。因此，通过自我报告非法药物使用或尿液毒理学分析无法获得的药物治疗的健康益处可能会通过标记物更好地反映 肝脏，血液，肾脏和免疫功能。退伍军人老龄化队列（VACS）指数增加了肝脏（丙型肝炎感染，FIB- 4），肾脏（eGFR）和血液学（血红蛋白，血小板）功能的测量，年龄，CD 4计数和HIV病毒载量，是一种经过验证的生物标志物指数，已被证明可以反映HIV感染患者免疫功能，饮酒量和整体健康状况的改善。拟议研究的目标是评估VACS指数作为一种生物标志物，反映在一系列三个子研究中减少物质使用的益处。目标1将在接受阿片类激动剂治疗的HIV感染阿片类药物依赖者中进行。使用尿液毒理学分析评估的非法阿片类药物使用的变化将与VACS指数的变化相关。目标2将HIV感染者自我报告的个别物质（阿片类药物，可卡因，大麻和烟草）使用的变化与VACS指数的变化相关联，并将药物使用期间获得的VACS指数结果与禁欲期间获得的结果进行比较。目标3将评估修改后的VACS指数（删除CD 4计数和HIV病毒载量）对接受阿片类激动剂治疗的未感染艾滋病毒的个体中阿片类药物使用变化的反应性，使用尿液毒理学分析进行评估。这一系列研究在一个大型的、特征良好的HIV感染和未感染HIV的患者队列中进行，这些患者具有关于实验室值、尿液毒理学试验和药物辅助治疗的广泛数据，这将增加我们对VACS指数所做的广泛验证工作。这项工作有可能提供证据，支持使用这一独特的常用实验室检测集合来监测减少非法药物使用对健康的益处。

DESCRIPTION (provided by applicant): The adverse effects of illicit drug use result from both direct toxicities and indirect effects due to infections, non-adherence to medical regimens, poor nutrition, and impaired self- care. These adverse effects are especially evident in HIV-infected individuals due to their high prevalence of comorbid conditions and physiologic frailty. Effective treatment of substance use disorders leading to reductions in illicit drug use can influence physiology in an equally diverse manner by reducing direct toxicities and improving medication adherence, nutrition and self-care. Therefore the health benefits of drug treatment not captured by self-report of illicit drug use or urine toxicology analyses, may be better reflected by markers of liver, hematologic, kidney, and immune function. The Veterans Aging Cohort (VACS) Index adds measures of liver (hepatitis C infection, FIB- 4), kidney (eGFR), and hematologic (hemoglobin, platelets) function to age, CD4 count and HIV viral load and is a validated biomarker index that has been shown to reflect improvement in immune function, alcohol consumption, and overall health in HIV- infected patients. The goals of the proposed research are to evaluate the VACS Index as a biomarker reflecting the benefits of reductions of substance use in a series of three sub studies. Aim 1 will be conducted in HIV-infected opioid dependent individuals receiving opioid agonist treatment. Changes in illicit opioid use assessed using urine toxicology analyses will be correlated with changes in the VACS Index. Aim 2 will correlate changes in self-reported use of individual substances (opioids, cocaine, marijuana, and tobacco) among HIV-infected subjects, with changes in the VACS Index and compare VACS Index results obtained during periods of drug use, with those obtained during periods of abstinence. Aim 3 will evaluate the responsiveness of a modified VACS Index (removing CD4 count and HIV viral load) to changes in opioid use, assessed using urine toxicology analysis, among HIV-uninfected individuals receiving opioid agonist treatment. This line of research conducted in a large and well characterized cohort of HIV-infected and HIV-uninfected patients with extensive data on laboratory values, urine toxicology tests, and medication-assisted treatment, will add to the extensive validation work we have done with the VACS Index. This work has the potential to provide evidence supporting the use of this unique aggregation of commonly available laboratory tests to monitor the health benefits of reduced illicit drug use.