HIV Disease Outcomes in Drug Users in Clinical Practice

JHHCC成立于1989年，是HIV纵向研究的主要来源，发表了250多篇关于HIV感染风险因素和结果的手稿。几乎一半的JHHCC患者有注射毒品使用史（IDU），使我们能够进行研究，直接比较来自同一地理和社会经济集水区的东部城市的IDU和非IDU患者之间的HIV护理的接收，依从性和临床结果，该城市具有很高的HIV感染率和发病率。在巴尔的摩，艾滋病毒感染仍处于流行水平，药物使用是一种共同流行病，阻碍了有效的艾滋病毒医疗的接受和连续性。 在乎在JHHCC存在的二十多年里，美国的艾滋病毒流行病经历了显着的演变。目前的抗逆转录病毒疗法（ART）在抑制病毒方面非常有效，与艾滋病有关的疾病大幅减少，预期寿命有所改善。然而，越来越多的证据表明，许多HIV相关非AIDS（HANA）合并症（如心血管、肾脏、肝脏、代谢和恶性疾病）的发生风险增加。虽然有争议，但艾滋病毒感染引起的“过早衰老”的概念是一个令人关切的问题。我们的第一个目标将建立在我们的纵向研究的优势，重点是艾滋病毒的进展，HANA和艾滋病毒感染的老龄化。JHHCC的另一个重点是病毒性肝炎合并感染，特别是肝炎 C，一种在我们的患者中普遍存在的合并症，主要是因为IDU。在我们的人群中，有效的丙型肝炎治疗存在重大障碍，但再次，治疗正在发生演变。新的直接作用的抗病毒药物正在迅速成为可用的，似乎更简单的使用和更有效地实现持续的病毒学反应。我们的第二个目标将集中在这些有前途的新疗法的利用率，依从性，障碍和结果。最后，JHHCC与150多名流行病学，临床，转化和卫生服务研究人员合作，提供现有数据，增加新的数据收集方法和工具，确定患者表型用于发病机制研究，临床试验和观察性研究，提供储存库标本并作为各种研究兴趣的研究平台。我们的第三个目标是扩大我们与研究人员的合作，他们将受益于JHHCC的资源。

DESCRIPTION (provided by applicant): The JHHCC, established in 1989, has been a premier source of HIV longitudinal research with over 250 manuscripts published on the risk factors and outcomes of HIV infection. Almost half of the JHHCC are patients with a history of injecting drug use (IDU), enabling us to conduct studies that directly compare receipt, adherence and clinical outcomes of HIV care between IDU and non-IDU patients from the same geographic and socioeconomic catchment areas of an Eastern city that has a high prevalence and incidence of HIV infection. HIV infection remains at epidemic levels in Baltimore, and substance use is a co-epidemic that is a barrier to receipt and continuity of effective HIV medical care. During the over two-decade existence of the JHHCC, the HIV epidemic in the U.S. has undergone a remarkable evolution. Current antiretroviral therapy (ART) is highly effective in suppressing virus and there has been a dramatic decline in AIDS-related disease and improvement in life-expectancy. However, there is growing evidence of an increased risk for the development of a number of HIV-associated non-AIDS (HANA) comorbidities such as cardiovascular, renal, liver, metabolic and malignant disease. Although controversial, the concept of "premature aging" from HIV infection is a concern. Our first Aim will build upon our strengths in longitudinal research focusing on HIV progression, HANA and aging with HIV infection. Another focus of the JHHCC has been viral hepatitis co-infection, particularly hepatitis C, a comorbidity that is prevalent in 45% of our patients, principally because of IDU. There have been substantial barriers to effective hepatitis C treatment in our population, but again, an evolution in therapy is occurring. Novel direct-acting antiviral drugs are rapidly becoming available that appear to be simpler to use and more effective in achieving a sustained virologic response. Our second Aim will focus on utilization, adherence, barriers and outcomes of these promising new therapies. Finally, the JHHCC has a proven history of collaboration with over 150 epidemiological, clinical, translational and health services investigators by providing existing data, adding new data collection methods and instruments, identifying patient phenotypes for pathogenesis studies, clinical trials and observational studies, supplying repository specimens and serving as a research platform for a variety of investigational interests. Our third Aim is to expand our collaborations with investigators who would benefit from the resources of the JHHCC.