AIDS Linked to the IntraVenous Experience (ALIVE) Study

Johns Hopkins University, Baltimore MD

Investigators

Linked publications & trials

Abstract

Ending the HIV epidemic (EHE) in the US by 2030 in people who inject drugs (PWID) is a national priority. While HIV incidence has declined among PWID, sporadic outbreaks have occurred driven by emerging drugs. Moreover, sustained viral suppression among aging PWID remains suboptimal. EHE goals recognize a need to extend beyond suppression, with increasing emphasis on approaches that address not only HIV outcomes but the complex chronic health conditions that co-occur with HIV and substance use. Since 1988, the AIDS Linked to the IntraVenous Experience (ALIVE) study has followed ~6000 people who inject drugs (PWID) in a community-based cohort in Baltimore, MD, a high priority EHE district with amongst the highest per capita overdose rate in the US. ALIVE has provided critical insights into the transmission and treatment of HIV among PWID – among whom HIV, substance use and chronic comorbidity commonly co-occur. In Baltimore, high levels of cocaine, heroin and fentanyl use are challenged by new emergence of methamphetamine with precipitous increases in xylazine and recent spikes in hepatitis C virus (HCV) incidence. At the same time, our cohort is experiencing increasing comorbidity, frailty and functional limitations necessitating an evolution in HIV care goals to incorporate a focus on whole-person health, well-being and associated drivers. We proposed to continue cutting-edge investigation into high impact research priorities (e.g., reducing HIV incidence, addressing HIV-associated comorbidities, coinfections and complications, providing infrastructure for cross-cutting research and training), expand efforts to inform policy while serving as a critical platform for a multidisciplinary epidemiological, behavioral and mechanistic studies and collaboration with multiple consortia. Our Specific Aims are: Aim 1. To extend the HIV care continuum beyond viral suppression by operationalizing life experience measurement and informing lifestyle interventions for approaches to healthy aging among PWID; Aim 2. To characterize the penetration of novel (e.g., xylazine, nitazene) and emerging (e.g., methamphetamine) substances within a population of PWID and evaluate impacts on HIV and HCV transmission, overdose and mortality. Aim 3. To inform local and national policy, fill gaps in existing NIH-funded HIV cohort research, and provide a platform for independently funded investigations of HIV, comorbidities, coinfections and drug use. ALIVE is unique in that it includes community-recruited, PWID with participants living with and without HIV, both in and out of medical care. Our aims address the critical questions at the intersection of HIV and substance use today, but the significance of ALIVE extends much further to answer other questions through 37 years of comprehensive behavioral, clinical and biological data along with a strong track record of collaboration.