Examining a Biopsychosocial Model of Neurocognitive Health for HIV-positive Sexual Minority Men

检查艾滋病毒阳性性少数男性神经认知健康的生物心理社会模型

• 批准号: 10392338
• 负责人: Laurel Anne Weaver
• 金额: $ 3.36万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392338
• 关键词: AIDS dementia; Acquired Immunodeficiency Syndrome; Adult; Affect; Age; Award; Blood Vessels; Chronic; Chronic stress; Clinical; Cognitive; Cognitive aging; Data; Development; Diagnosis; Education; Enrollment; Epidemic; Etiology; Exhibits; Exposure to; Fibrinogen; Financial cost; Fostering; Funding; Future; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV-associated neurocognitive disorder; Health; Height; High Prevalence; Homelessness; Incidence; Individual; Inflammatory; Injury; Interleukin-6; Intervention; Investigation; Longevity; Maintenance; Measurable; Mediating; Mental Depression; Mental Health; Minority; Modeling; Modernization; Neurobiology; Neurocognitive; Neurocognitive Deficit; Neuronal Injury; Neurons; Outcome; Parents; Participant; Physiological; Population; Poverty; Predisposition; Prevalence; Prevention strategy; Process; Psychological Stress; Psychosocial Factor; Public Health; Reporting; Research; Research Design; Research Training; Risk; Risk Factors; Role; Sampling; Scientist; Social Environment; Social Psychology; Statistical Methods; Stress; Structure; Testing; Time; Training; Translational Research; Trauma; United States National Institutes of Health; Viral Load result; Virus Replication; Work; antiretroviral therapy; base; behavioral health; biological adaptation to stress; biopsychosocial; cognitive function; cognitive reserve; comorbidity; contextual factors; cytokine; disorder risk; epidemiologic data; experience; health disparity; high risk; human old age (65+); immune health; insight; men; men' s group; modifiable risk; neurocognitive test; neuroinflammation; neurotoxic; novel; parent project; pediatric trauma; physical conditioning; prevent; psychologic; psychological stressor; public health relevance; resilience; sexual identity; sexual minority; social neuroscience; social stigma; social structure; theories; treatment strategy

PROJECT SUMMARY/ABSTRACT Neurocognitive impairment (NCI) has disproportionately impacted the HIV+ population since the height of the AIDS crisis. Though modern antiretroviral therapy has afforded vast improvements in longevity, the overall prevalence of HIV-associated neurocognitive disorders (HAND) has remained stable for three decades. Sexual minority men (SMM) have comprised the majority of all HIV diagnoses in the U.S. for the duration of the epidemic. However, few studies have explored the notion that SMM may be correspondingly overrepresented in the high proportion of HIV+ individuals impacted by NCI. Moreover, understanding of HAND etiology is currently limited, which has hindered the development of empirically supported prevention and treatment strategies for HAND. Research suggests that the chronic inflammatory action of HIV infection places HIV+ individuals at a higher risk for NCI, but despite common vulnerability to neuroinflammation, approximately half of HIV+ individuals exhibit normative cognitive function across the lifespan, suggesting that individual-level contextual factors underlie cognitive risk and resiliency. Chronic stress has also been associated with neuroinflammation, via increases in pro-inflammatory cytokines. Building upon theories of syndemics and minority stress, this investigation is based on a novel hypothesis that socio-structural syndemic factors (e.g., poverty, trauma) additively interact with minority stress (i.e., chronic psychological stress related to one’s sexual identity) to diminish cognitive reserve (i.e., neuronal resilience against injury). Furthermore, we hypothesize that chronically high levels of inflammatory cytokines represent a potential causative mechanism through which minority stress negatively impacts cognitive health. As such, the project focuses on three aims: (1) to test the hypothesis the NCI risk will increase with the number of psychological (i.e., minority stress) and socio-structural syndemic (e.g., low education, homelessness) factors reported by HIV+SMM; (2) examine the interactive impact of minority stress and socio-structural syndemic vulnerabilities on NCI risk; and (3) assess the mediating role of elevated pro-inflammatory cytokines (e.g., IL-6) in the hypothesized association between minority stress and NCI risk. The proposed project will be embedded into a larger study (R01MH114735, PI: Rendina), referred to herein as the parent project, which is actively enrolling 250 HIV+ SMM to examine the role of minority and HIV-related stress on psychological, behavioral, and immunological health outcomes. The proposed project will add one assessment to the parent project’s existing neurocognitive test battery to allow for a more nuanced understanding of the cognitive health profile of HIV+ SMM. The research and training plans guiding this proposal have been carefully crafted to optimize my ongoing doctoral training experiences and foster my development as a future independent research scientist.

项目概要/摘要 自艾滋病高峰期以来，神经认知障碍 (NCI) 对 HIV+ 人群的影响尤为严重 尽管现代抗逆转录病毒疗法极大地延长了寿命，但总体而言。 三十年来，艾滋病毒相关神经认知障碍（HAND）的患病率一直保持稳定。 在此期间，少数族裔男性 (SMM) 占美国所有艾滋病毒诊断的大多数 然而，很少有研究探讨 SMM 的代表性可能相应过高。 此外，对 HAND 病因的了解也很广泛。 目前有限，这阻碍了经验支持的预防和治疗的发展 研究表明，HIV 感染的慢性炎症作用会导致 HIV+。 患 NCI 的风险较高的个体，但尽管普遍容易受到神经炎症的影响，但大约一半的人 HIV+ 个体在整个生命周期中表现出正常的认知功能，这表明个体水平 认知风险和弹性的背景因素也与慢性压力有关。 神经炎症，通过促炎细胞因子的增加建立在综合征和理论的基础上。 少数族裔压力，这项调查基于一个新的假设，即社会结构综合症因素（例如， 贫困、创伤）与少数人压力（即与个人的经历相关的慢性心理压力）相互作用。 性别认同）以减少认知储备（即神经对损伤的恢复能力）。 证实长期高水平的炎症细胞因子是潜在的致病机制 少数群体的压力会影响消极的认知健康 因此，该项目重点关注三个目标： (1) 检验 NCI 风险将随着心理（即少数族裔压力）和数量的增加而增加的假设 HIV+SMM 报告的社会结构综合症（例如，教育程度低、无家可归）因素；(2) 检查 少数群体压力和社会结构综合症脆弱性对 NCI 风险的交互影响；以及 (3) 评估 升高的促炎细胞因子（例如 IL-6）在两者之间的开创性关联中的介导作用 拟议的项目将纳入一项更大规模的研究（R01MH114735，PI： Rendina），此处称为父项目，该项目正在积极招募 250 名 HIV+ SMM 来检查 少数群体和艾滋病毒相关压力对心理、行为和免疫健康结果的作用。 拟议的项目将在父项目现有的神经认知测试电池中添加一项评估，以允许 更细致地了解 HIV+ SMM 的认知健康状况 研究和培训。 指导该提案的计划经过精心设计，以优化我正在进行的博士培训经历 并促进我作为未来独立研究科学家的发展。