Treatment outcomes and comorbidity in HIV-infected IDU

描述(由申请者提供)：这是为约翰·霍普金斯医学院副教授格雷戈里·卢卡斯博士颁发的以患者为中心的研究生涯中期研究员奖的建议。卢卡斯博士接受过传染病专家的医学培训，并于2004年在彭博公共卫生学院完成了临床调查博士学位。他的研究生涯侧重于改善注射吸毒者获得护理的机会和结果的干预措施，以及慢性肾脏疾病，这是一种与艾滋病毒相关的常见共病，在注射吸毒者中尤为普遍。注射吸毒仍然是全世界艾滋病毒传播的重要方式，是实现最佳艾滋病毒治疗结果的一贯障碍，也是医疗合并症和早期死亡的风险因素。这项提议的目标是支持一项指导初级调查人员和促进创新研究的计划。这笔赠款讨论了两个活跃的研究平台，这两个平台将作为框架，让受训人员参与以患者为中心的艾滋病毒相关研究。首先，卢卡斯博士是肾脏疾病队列的PI，旨在评估HIV感染和HIV阴性受试者队列中艾滋病毒、丙型肝炎和活性药物使用对肾脏和心血管疾病的作用。这项研究包括对碘海醇清除量的纵向测量(肾小球滤过率的黄金标准测量)，心血管疾病的替代测量，以及通过储存的标本评估可能的机制和新的生物标记物的机会。第二，卢卡斯博士参与了一项整群随机试验，以评估印度对IDU友好的综合护理中心(ICCs)的有效性。在基线数据收集和分层之后，印度的12个IDU流行地点 将被随机分成ICC组或对照组。在国际刑事法院的6个站点，面向戒毒者的非政府组织将扩大规模，除提供咨询和减少风险服务外，还将提供免费的艾滋病毒检测和现场抗逆转录病毒治疗。在服务提供两年后，将通过对每个试验点和控制点的1000名注射吸毒者进行答复者驱动的抽样调查来评估社区一级的成果。除了这些研究平台，卢卡斯博士还计划通过对约翰·霍普金斯艾滋病研究中心(CFAR)的重大承诺以及他在北美艾滋病研究与设计合作(NA ACCORD)中担任肾脏疾病工作组主任的角色，帮助初级研究人员进入艾滋病毒临床研究。约翰霍普金斯大学出色的艾滋病毒研究环境是这一提议的关键背景。卢卡斯博士的培训、经验和职业目标非常适合K24奖项的目标。

DESCRIPTION (provided by applicant): This is a proposal for a midcareer investigator award in patient-oriented research for Dr. Gregory Lucas, Associate Professor at the Johns Hopkins School of Medicine. Dr. Lucas is medically trained as an infectious diseases specialist and he completed a PhD in clinical investigation at the Bloomberg School of Public Health in 2004. His research career focuses on interventions to improve access to care and outcomes among injection drug users (IDUs), and on chronic kidney disease, a common HIV-related comorbidity that is especially prevalent among IDUs. Injection drug use remains an important mode of HIV transmission worldwide, is a consistent barrier to optimal HIV treatment outcomes, and is a risk factor for medical comorbidity and early mortality. The objective of this proposal is to support a program for mentoring junior investigators and for fostering innovative research. This grant discusses two active research platforms that will serve as a framework for engaging trainees in HIV-related patient-focused research. First, Dr. Lucas is PI of kidney disease cohort designed to assess the roles of HIV, hepatitis C, and active drug use on kidney and cardiovascular disease in a cohort of HIV-infected and HIV-negative subjects. This study includes longitudinal measurements of iohexol clearance (a gold-standard measure of glomerular filtration rate), surrogate measures of cardiovascular disease, and the opportunity to assess putative mechanisms and novel biomarkers through stored specimens. Second, Dr. Lucas is co-PI of a cluster-randomized trial to evaluate the effectiveness of IDU-friendly integrated care centers (ICCs) in India. After baseline data collection and stratification, 12 IDU-prevalent sites in India will be randomized to ICC or control. In the 6 ICC sites, IDU- oriented non-governmental organizations will be scaled-up to provide free HIV testing and on-site ART, in addition to counseling and risk reduction services. After 2 years of service delivery, community-level outcomes will be evaluated with respondent-driven sampling surveys of 1,000 IDUs in each experimental and control site. In addition to these research platforms, Dr. Lucas proposes plans to assist the entry of junior investigators into HIV clinical research through a major commitment to the Johns Hopkins Center for AIDS Research (CFAR) and through his role as kidney disease working group director in the North American AIDS Cohort Collaboration on Research and Design (NA ACCORD). The outstanding environment for HIV research at Johns Hopkins is a key backdrop to this proposal. Dr. Lucas's training, experience, and career goals are well- suited to the objectives of the K24 award.