This proposal is submitted as a competing renewal of R01DA11602, "HIV Disease Outcomes in Drug Users in Clinical Practice." This research is based in the Johns Hopkins HIV Clinical Cohort (JHHCC), established in to investigate HIV therapeutics and disease progression in clinical practice, with a special focus on injecting drug using (IDU) and non-IDU patients. Since the introduction of HAART in the U.S., HIV infection has largely evolved into a chronic disease. HIV/AIDS research questions have also evolved as the epidemic has matured. Before HAART, our research found comparability in disease progression between IDU and non-IDU patients. We demonstrated an early reduction in AIDS and mortality among both groups after HAART was introduced. During the past 5 years, our research has shown that IDU is a significant barrier to receiving and adhering to HAART, to achieving effective viral and immunologic improvement on HAART, and to attaining the cprominent than we have seen before, i.e., liver, renal, cardiovascular and metabolic diseases, and malignancy. Long-term survival with HIV and exposure to antiretrovirals, an aging host population, and long-term use of illicit drugs may all contribute to the incidence of these comorbidities, and raises new questions about the clinical course of non-AIDS-related morbidity and mortality among IDUs and non-IDUs.
Our specific aims are to, 1) Evaluate HIV disease progression among IDU and non-IDU patients as the HIV epidemic continues to mature and change in the setting of continuing advances in HAART and in the context of the clinical epidemiology of IDU, and, 2) Characterize the development and progression of non-AIDS related illnesses among IDU and non-IDU patients in the setting of longer survival, long-term antiretroviral exposure, an aging population, and in the context of relapse and remission of IDU, 3) Characterize HIV disease progression the viral hepatitis co-infected patient, d treatment for AIDS, the JHHCC is in an excellent position to identify emerging challenges for medical management of HIV infection and co-infections associated with drug addiction and the long-term consequences of HAART.

Public Health Relevance

Modern HIV therapy has allowed people with HIV infection to live longer lives, but the benefits may be less in patients who have injected drugs than in others. Non-AIDS related illnesses may also be occurring at higher rates than might otherwise be expected. We propose to study to compare the outcomes of HIV therapy in injecting drug using vs. non-drug using patients as the use of highly active antiretroviral therapy is now in its second decade.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA011602-14
Application #
8248189
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Lambert, Elizabeth
Project Start
1998-08-01
Project End
2014-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
14
Fiscal Year
2012
Total Cost
$683,258
Indirect Cost
$266,637
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Haines, Charles F; Fleishman, John A; Yehia, Baligh R et al. (2014) Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era. J Acquir Immune Defic Syndr 67:84-90
Althoff, Keri N; Rebeiro, Peter; Brooks, John T et al. (2014) Disparities in the quality of HIV care when using US Department of Health and Human Services indicators. Clin Infect Dis 58:1185-9
IeDEA and ART Cohort Collaborations; Avila, Dorita; Althoff, Keri N et al. (2014) Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 65:e8-16
Rebeiro, Peter F; Horberg, Michael A; Gange, Stephen J et al. (2014) Strong agreement of nationally recommended retention measures from the Institute of Medicine and Department of Health and Human Services. PLoS One 9:e111772
Konerman, Monica A; Mehta, Shruti H; Sutcliffe, Catherine G et al. (2014) Fibrosis progression in human immunodeficiency virus/hepatitis C virus coinfected adults: prospective analysis of 435 liver biopsy pairs. Hepatology 59:767-75
Piwowar-Manning, Estelle; Fogel, Jessica M; Laeyendecker, Oliver et al. (2014) Failure to identify HIV-infected individuals in a clinical trial using a single HIV rapid test for screening. HIV Clin Trials 15:62-8
Ishwaran, Hemant; Gerds, Thomas A; Kogalur, Udaya B et al. (2014) Random survival forests for competing risks. Biostatistics 15:757-73
Cousins, Matthew M; Konikoff, Jacob; Sabin, Devin et al. (2014) A comparison of two measures of HIV diversity in multi-assay algorithms for HIV incidence estimation. PLoS One 9:e101043
Cousins, Matthew M; Konikoff, Jacob; Laeyendecker, Oliver et al. (2014) HIV diversity as a biomarker for HIV incidence estimation: including a high-resolution melting diversity assay in a multiassay algorithm. J Clin Microbiol 52:115-21
Hurt, Christopher B; Napravnik, Sonia; Moore, Richard D et al. (2014) Hepatic safety and tolerability of raltegravir among HIV patients coinfected with hepatitis B and/or C. Antivir Ther 19:415-22

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