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 i s 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 i s 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).

Public Health Relevance

This research will provide needed information on the clinical course and outcomes for persons with HIV (PWH) engaged in HIV care. Due to national efforts, the majority of PWH are care and improved treatments promise a multi-decade lifespan. We will provide data on how substance use impacts this lifespan, particularly on the occurrence of non-AIDS comorbidity, survival and the outcomes of viral hepatitis. We have, and will continue to collaborate with others in this effort.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project--Cooperative Agreements (U01)
Project #
2U01DA036935-06
Application #
9992139
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Schulden, Jeffrey D
Project Start
2014-07-01
Project End
2025-03-31
Budget Start
2020-05-01
Budget End
2021-03-31
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
Jiang, Wei; Luo, Zhenwu; Martin, Lisa et al. (2018) Drug Use is Associated with Anti-CD4 IgG-mediated CD4+ T Cell Death and Poor CD4+ T Cell Recovery in Viral-suppressive HIV-infected Individuals Under Antiretroviral Therapy. Curr HIV Res 16:143-150
Lesko, Catherine R; Keil, Alexander P; Moore, Richard D et al. (2018) Measurement of Current Substance Use in a Cohort of HIV-Infected Persons in Continuity HIV Care, 2007-2015. Am J Epidemiol 187:1970-1979
Bengtson, Angela M; Pence, Brian W; Eaton, Ellen F et al. (2018) Patterns of efavirenz use as first-line antiretroviral therapy in the United States: 1999-2015. Antivir Ther 23:363-372
Lai, Shenghan; Heaphy, Christopher M; Rizzo, Anthony J et al. (2018) Cocaine use may induce telomere shortening in individuals with HIV infection. Prog Neuropsychopharmacol Biol Psychiatry 84:11-17
AIDS-defining Cancer Project Working Group of IeDEA, COHERE in EuroCoord (2018) Non-Hodgkin lymphoma risk in adults living with HIV across five continents. AIDS 32:2777-2786
Elion, Richard A; Althoff, Keri N; Zhang, Jinbing et al. (2018) Recent Abacavir Use Increases Risk of Type 1 and Type 2 Myocardial Infarctions Among Adults With HIV. J Acquir Immune Defic Syndr 78:62-72
Grover, Surbhi; Desir, Fidel; Jing, Yuezhou et al. (2018) Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis. J Acquir Immune Defic Syndr 79:421-429
Lesko, Catherine R; Lau, Bryan; Chander, Geetanjali et al. (2018) Death after diagnosis of non-communicable disease comorbid conditions, stratified by injection drug use. AIDS :
Yanik, Elizabeth L; Hernández-Ramírez, Raúl U; Qin, Li et al. (2018) Brief Report: Cutaneous Melanoma Risk Among People With HIV in the United States and Canada. J Acquir Immune Defic Syndr 78:499-504
Calkins, Keri L; Lesko, Catherine R; Chander, Geetanjali et al. (2018) Influence of Injection Drug Use-Related HIV Acquisition on CD4 Response to First Antiretroviral Therapy Regimen Among Virally Suppressed Individuals. J Acquir Immune Defic Syndr 77:317-324

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