Johns Hopkins HIV Clinical Cohort

约翰霍普金斯艾滋病毒临床队列（JHHCC）自1989年以来一直是纵向研究的资源。 研究艾滋病毒感染者的风险因素、治疗和临床结果。巴尔的摩酒店 该区域艾滋病毒感染和药物使用（主要是海洛因和可卡因）流行重叠 使用，我们的大部分研究都集中在这个人群中，具有直接比较的优势 使用药物的人与来自相同地理和社会经济背景的非使用人群 该地区的集水区。我们的队列主要是非洲裔美国人， 妇女，提供了一个必要的窗口，了解这些流行病在这些往往研究不足的人口。 高效的抗逆转录病毒疗法（ART）显著提高了生存率; JHHCC队列为54岁，预期寿命为20-30岁。新的联邦举措 目标是使90%以上的公共卫生服务提供者参与艾滋病毒护理，以便更好地了解和克服挑战， 长期艾滋病毒护理与当代流行病特别相关。我们目前的目标建立在 我们在纵向研究方面的优势，侧重于长期感染的慢性患者人群， 非传染性疾病（NCD）的发病率似乎更高， 年龄比预期的要大，即使是那些病毒抑制的人。我们和其他人已经证明， 药物使用是实现艾滋病毒护理连续体成果的障碍，并增加了风险 艾滋病并发症和死亡率。我们的第一个目的是描述PWH的扩展临床过程 在当代艾滋病护理中，评估阿片类药物和其他物质使用的关联及其 艾滋病毒护理连续体的治疗，艾滋病毒感染者的非传染性疾病发病率和死亡率。另一 JHHCC的焦点是病毒性肝炎合并感染，特别是丙型肝炎（HCV）， 这在我们40%的病人中很普遍，主要是因为IDU。虽然我们现在有效地 治疗丙型肝炎病毒，挑战仍然存在于治愈那些谁使用的物质和那些谁是治疗，肝 纤维化是常见的，未来肝硬化、脂肪变性和肝癌的风险尚不清楚， 再次感染的风险。我们的第二个目标将集中在HCV治疗和这些疾病的发生率和风险上。 不良肝脏结果和已接受治疗者的再感染。最后，JHHCC有一个 经过验证的高效合作历史，拥有500多份出版物，其中一半与 多站点协作。这些研究不仅包括观察性研究，还包括 发病机理、实施科学和临床试验。我们的第三个目标是加强与 调查人员谁将受益于JHHCC的资源，特别是作为一部分， 生产NIDA机会的合作群体联盟（C3 PNO）。

The Johns Hopkins HIV Clinical Cohort (JHHCC) has been a resource since 1989 for longitudinal research on the risk factors, treatment and clinical outcomes of persons with HIV (PWH). The Baltimore region has overlapping epidemics of HIV infection and substance use, predominantly heroin and cocaine use, and much of our research has focused in this population, with the advantage of directly comparing those who use substances with a non-use population from the same geographic and socioeconomic catchment areas of the region. Our cohort is predominantly African-American with a high proportion of women, providing a needed window into these epidemics in these often understudied populations. Highly-effective antiretroviral therapy (ART) has markedly improved survival; the median age of the JHHCC cohort is 54 years with an expected life-expectancy of 20-30 years. New federal initiatives have a goal of >90% of PWH in HIV care, so that data to better understand and overcome the challenges to long-term HIV care are particularly relevant to the contemporary epidemic. Our current Aims build upon our strengths in longitudinal research, focusing on the chronically-infected patient population on long- term ART. Non-communicable diseases (NCD) appear to be occurring at higher rates and at earlier ages than expected, even in those who are virally suppressed. We and others have shown that substance use is a barrier to achieving the outcomes of the HIV Care Continuum, and increases the risk of comorbidity and mortality in HIV. Our first Aim is to characterize the extended clinical course of PWH in contemporary HIV care, evaluating the associations of opioid and other substance use and its treatment with the HIV Care Continuum, NCD morbidity and mortality in those aging with HIV. Another focus of the JHHCC has been viral hepatitis co-infection, particularly hepatitis C (HCV), a comorbidity that is prevalent in 40% of our patients, principally because of IDU. Although we are now effectively treating HCV, challenges remain in curing those who use substances and in those who are treated, liver fibrosis is common and the future risk of cirrhosis, steatosis and hepatic cancer is unclear, as well as the risk of re-infection. Our second Aim will focus on HCV treatment and the rates and risks of these adverse liver outcomes and re-infection in those who have been treated. Finally, the JHHCC has a proven history of highly productive collaboration, with over 500 publications, half of which are with multisite collaborations. These include not only observational research, but translational studies of pathogenesis, implementation science and clinical trials. Our third Aim is to enhance collaboration with investigators who would benefit from the resources of the JHHCC, and especially as part of the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO).