Community-Engaged Research on COVID-19 Testing Among Underserved and/or Vulnerable Populations

摘要 在美国，肝病是艾滋病毒感染者死亡的主要原因。虽然先进的技术 抗逆转录病毒治疗显著降低了艾滋病毒相关死亡率，与丙型肝炎病毒重叠感染 丙型肝炎病毒(丙型肝炎病毒)广泛存在，加速了肝纤维化向肝硬变和肝癌的发展。在……里面 此外，药物滥用会加速HIV疾病，并可能促进肝纤维化的进展。这个 这项建议的主要目标是继续遵循现有的迈阿密成人艾滋病毒研究(MASH)队列， 其标本储存库和数据库，并将其从目前的881名研究参与者扩大到1500名。这个 目的是产生合作研究，以调查可卡因的影响，目前为止，可卡因是最普遍的 关于南佛罗里达州滥用药物、艾滋病毒感染、艾滋病毒/丙型肝炎病毒混合感染以及长期发病率的研究 重点关注这一人群中的肝病，这些人群在获得医疗服务方面存在差异。未感染艾滋病毒和丙型肝炎病毒的可卡因 还将招募吸毒者和非吸毒者，以便能够确定单独使用可卡因的影响 因为可卡因的使用与艾滋病毒、丙型肝炎病毒和艾滋病毒/丙型肝炎病毒共同感染的相互作用。作为新的和更有效的 艾滋病毒、丙型肝炎病毒和药物滥用的治疗和护理变得可用，保持良好的- 特色化的队列、标本库和数据库将为当前 以及未来的合作研究。观察丙型肝炎病毒新疗法和潜在的新可卡因的吸收情况 在这一有健康差距的高危人群中的戒烟计划将提供有关障碍和促进者的数据 到有效的治疗，以防止长期发病率和死亡率。我们已经跟踪了MASH队列中的881人 参与者拥有长达12年的出色保留率，并创建了一个标本库和一个 数据库。迈阿密的MASH队列是独一无二的，因为它将是一个以西班牙裔为主的队列，有大量的 非裔美国人，女性，非注射吸毒者，主要是异性恋艾滋病毒携带者- 传播病因学。我们建议(1)比较以下四年中肝纤维化的进展 可卡因吸毒者和非吸毒者在HIV+/丙型肝炎病毒-、HIV+/丙型肝炎病毒+、HIV-/丙型肝炎病毒+和HIV-/丙型肝炎病毒-中，使用一种新的非 侵入性诊断设备，磁共振弹性成像(MRE)。我们还建议(2)比较 四年来生物标志物的模式和识别与肝脏机制相关的遗传标志物 可卡因吸毒者和非吸毒者之间的纤维化。了解可卡因使用在艾滋病毒和艾滋病方面的作用 艾滋病毒/丙型肝炎病毒混合感染和可卡因戒断治疗缺乏持久影响对于 了解其发病机制和疾病转归，并为确定抗纤维化药物提供依据。 氧化应激等治疗方法，这是可以干预的。这些研究将对 计划的制定，适当的干预，以及改善这一人群的健康。

ABSTRACT Liver disease is a major cause of death in HIV infected persons in the United States. While advances in antiretroviral therapy have significantly reduced HIV-related mortality, co-infection with hepatitis C virus (HCV), is widespread and accelerates progression of liver fibrosis to cirrhosis and liver carcinoma. In addition, substance abuse accelerates HIV disease, and may facilitate progression of liver fibrosis. The primary goal of this proposal is to continue to follow the existing Miami Adult Studies on HIV (MASH) cohort, its specimen repository and database, and expand it from the current 881 to 1,500 study participants. The purpose is to generate collaborative studies to investigate the impact of cocaine, by far the most prevalent drug of abuse in South Florida, on HIV infection, HIV/HCV co-infection, and on long-term morbidity with a focus on liver disease in this population with disparities in access to care. HIV and HCV un-infected cocaine users and non-users will also be recruited to allow determination of the impact of cocaine use alone, as well as the interaction of cocaine use with HIV, HCV, and HIV/HCV co-infection. As new and more effective treatments and access to care for HIV, HCV and drug abuse become available, maintaining a well- characterized cohort, specimen repository and database will create a strong resource platform for current and future collaborative research. Observing the uptake of new HCV treatments and potential new cocaine cessation programs in this at-risk population with health disparities will provide data on barriers and facilitators to effective treatments to prevent long-term morbidity and mortality. We have followed the MASH cohort of 881 participants for up to 12 years with excellent retention rates, and have created a specimen repository and a database. The MASH cohort in Miami is unique because it will be a mostly Hispanic cohort with a large number of African Americans, women, non-injector drug users, with predominantly heterosexual HIV- transmission etiology. We propose to (1) compare the progression of liver fibrosis over four years among cocaine users and non-users in HIV+/HCV-, HIV+/HCV+, HIV-/HCV+, and HIV-/HCV-, using a novel non- invasive diagnostic device, the Magnetic Resonance Elastography (MRE). We also propose to (2) compare the pattern over four years of biomarkers and identify genetic markers associated with the mechanisms of liver fibrosis among cocaine users and non-users. Understanding the role of cocaine use in the context of HIV and HIV/HCV co-infections and lack of lasting effects of treatments for cocaine use cessation are crucial in order to gain insights into the pathogenesis and disease outcomes, and to provide the basis for identifying antifibrotic therapies such as oxidative stress, which are amenable to intervention. These studies will be critical for program development, appropriate interventions, and for improving health in this population.