HIV Disease Outcomes in Drug Users in Clinical Practice

简介(申请人提供)：成立于的中国人类免疫缺陷病毒研究中心是艾滋病毒纵向研究的主要来源，发表了250多篇关于艾滋病毒感染的危险因素和结局的论文。近一半的JHCC患者有注射毒品(IDU)史，这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IDU和非IDU患者接受艾滋病毒护理的情况、依从性和临床结果，该地区是艾滋病毒感染率和发病率较高的东部城市。在巴尔的摩，艾滋病毒感染仍然处于流行水平，而药物使用是一种共同流行，这是接受和持续有效的艾滋病毒医疗的障碍 关心。在JHCC存在的20多年里，美国的艾滋病毒流行经历了显著的演变。目前的抗逆转录病毒疗法(ART)在抑制病毒方面非常有效，艾滋病相关疾病的发病率大幅下降，预期寿命有所改善。然而，越来越多的证据表明，发生一些艾滋病毒相关的非艾滋病(HANA)共病的风险增加，如心血管、肾脏、肝脏、代谢和恶性疾病。尽管存在争议，但艾滋病毒感染导致的“过早衰老”的概念是一个令人担忧的问题。我们的第一个目标将建立在我们在专注于艾滋病毒进展、HANA和老龄化与艾滋病毒感染的纵向研究方面的优势。JHHCC的另一个焦点是病毒性肝炎合并感染，特别是肝炎 C，这是一种在我们45%的患者中普遍存在的共病，主要是由于IDU。在我们的人群中，有效的丙型肝炎治疗存在实质性的障碍，但再次，治疗方法正在发生演变。新的直接作用抗病毒药物正在迅速出现，这些药物似乎更容易使用，在实现持续的病毒学反应方面也更有效。我们的第二个目标将集中在这些有希望的新疗法的使用、依从性、障碍和结果上。最后，JHHC拥有与150多名流行病学、临床、转化和卫生服务研究人员合作的良好历史，提供现有数据，添加新的数据收集方法和工具，为发病机制研究、临床试验和观察性研究识别患者表型，提供存储库标本，并为各种研究兴趣提供研究平台。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JHCC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.