2/6 COMpAAAS U01: Observation Study

总结 在接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（HIV+）中，多药治疗的比例是三倍 比没有感染的人更常见，并且早10年发生。可能是由于更大的生理 艾滋病毒感染者的虚弱、多药（5种以上慢性药物）也与更高的死亡率有关。 潜在不适当的药物（PIM）是那些可能导致更多的伤害比药物的好处。 相互作用和不良反应，这些增加与多药。65岁以上的PIM标准 奥尔兹（老化PIM）已确定，但尚未在艾滋病毒阳性个体中得到验证。此外，ART 饮酒也会增加PIM。我们不知道哪些非ART药物治疗（合并用药）是 对HIV+饮酒者有益而实际上有害。相反，艾滋病毒和酒精使用也可能是一个 接受辅助药物治疗的障碍。在有限的证据面前，提供者可能不愿意治疗 酒精使用障碍（AUD）与药物之间的艾滋病毒+个人由于安全问题。此外，酒精 使用是HCV治疗的相对禁忌症。因此，饮酒者可能会选择报告酒精含量 用于获得直接作用剂（DAA），但可能会经历更多的伤害和更少的好处。我们提请 在退伍军人老龄化队列研究丰富的纵向临床数据，并加强它的战略 额外的数据收集和创新技术，以纠正测量中的系统误差， 因适应症而混淆。我们将量化衰老、ART和酒精PIM的影响， AUD和HCV药物治疗对患者显著结局（PSO）的影响，包括死亡率、住院治疗， 具有医学意义的福尔斯、细菌性肺炎和谵妄，以告知药物的优先顺序，并限制 HIV+患者中的多重药物治疗的危害。我们的研究是及时和创新的。复方制剂是 正常，AUD正在治疗中，HCV的DAA最近才可用。而其他人则 量化的PIM，我们将衡量其对PSO的实际影响。我们还将衡量 在HIV+和未感染饮酒者中进行AUD和HCV药物治疗。这些研究报告将 有助于设计电子健康干预措施，促进个性化护理和简化合作 HIV+个体的药物治疗（见U24s CHAMP & RIB）。

Summary Among those with HIV infection (HIV+) on antiretroviral therapy (ART), polypharmacy is three times more common than among those without infection and occurs 10 years earlier. Likely due to greater physiologic frailty, polypharmacy (5+ chronic medications) among those with HIV is also associated with greater mortality. Potentially inappropriate medications (PIMs) are those which likely cause more harm than benefit due to drug interactions and adverse reactions and these increase with polypharmacy. While criteria for PIMs among 65+ year olds (Aging PIMs) are established, they have not been validated among HIV+ individuals. Further, ART and alcohol use also increase PIMs. We do not know which non ART pharmacotherapies (co medications) are helpful and which are actually harmful among HIV+ who drink. Conversely, HIV and alcohol use may also be a barrier to receipt of helpful co medications. In the face of limited evidence, providers may be reluctant to treat Alcohol Use Disorder (AUD) with medications among HIV+ individuals due to safety concerns. Further, alcohol use is a relative contraindication for HCV treatment. As a result, drinkers may choose to under report alcohol use to gain access to direct acting agents (DAAs) but may experience more harm and less benefit. We draw on the rich, longitudinal clinical data in the Veterans Aging Cohort Study and enhance it with strategic additional data collection and innovative techniques to correct for systematic error in measurement and confounding by indication. We will quantify the impact of Aging, ART and Alcohol PIMs and of pharmacotherapies for AUD and HCV on patient salient outcomes (PSOs) including mortality, hospitalization, medically significant falls, bacterial pneumonia, and delirium to inform prioritization of medications and limit harm from polypharmacy among HIV+ individuals. Our study is timely and innovative. Polypharmacy is the norm, AUD is under treated, and DAAs for HCV have only recently become available. While others have quantified PIMs, we will measure their actual impact on PSOs. We will also measure the benefit from pharmacotherapy for AUD and HCV among HIV+ and uninfected individuals who drink. These studies will be instrumental in the design of eHealth interventions facilitating personalized care and simplification of co medications among HIV+ individuals (see U24s CHAMP & RIB).