Assessing Syndemics of Cardiovascular Disease in People with and without HIV

评估感染者和未感染者的心血管疾病综合征

• 批准号: 10541067
• 负责人: Derek D Satre
• 金额: $ 72.2万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10541067
• 关键词: Address; Age; Alcohols; Anti-Retroviral Agents; Atrial Fibrillation; Biological; Biological Factors; Biological Markers; Biological Specimen Banks; Body Weight; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Community Health Systems; Coronary; Data; Data Sources; Development; Discrimination; Disease; Disease Outcome; Disease Progression; Dyslipidemias; Economic Conditions; Economic Factors; Elderly; Electronic Health Record; Emotional; Enrollment; Evaluation; Event; Functional disorder; Future; General Population; Geography; Goals; HIV; HIV Infections; Health; Health Services Accessibility; Healthcare Systems; Heart failure; High Prevalence; Homelessness; Immunologic Deficiency Syndromes; Inflammation; Insurance Benefits; Integrase; Intervention; Interview; Joints; Knowledge; Lead; Link; Measures; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Myocardial Infarction; Neighborhoods; Obesity; Patients; Peripheral arterial disease; Persons; Population; Public Health; Recording of previous events; Research; Resources; Risk; Risk Factors; Sampling; Smoking; Social Conditions; Social isolation; Stigmatization; Stroke; Substance Use Disorder; Surveys; Toxic effect; Trauma; Vulnerable Populations; Woman; antiretroviral therapy; base; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; care systems; cohort; comparison group; deprivation; design; follow-up; health care availability; health care disparity; high risk; housing instability; inhibitor; marginalized population; men; mortality; preventive intervention; pro-brain natriuretic peptide (1-76); recruit; response; social; social factors; social relationships; social stigma; substance use; syndemic; synergism; treatment disparity

PROJECT SUMMARY/ABSTRACT Combination antiretroviral therapy (ART) has led to dramatic declines in morbidity and mortality for people with HIV (PWH). However, as PWH age, the risk of cardiovascular disease (CVD) has increased, with a projected lifetime burden among PWH of 65% for men and 44% for women. The higher observed risk of CVD in PWH compared with the general population is a result of the higher prevalence of established CVD risk factors (smoking, alcohol, dyslipidemia), and direct effects of HIV infection, including immunodeficiency and inflammation. Recent studies have also implicated integrase strand inhibitors and other ART with increases in body weight, which may further increase risk of CVD. There are also many understudied social and economic conditions that may contribute to the high CVD risk in PWH, including disparities in healthcare access and treatment, social isolation, history of trauma, and HIV stigma. While most studies have considered the impact of CVD risk factors in isolation, it is well known that many frequently co-occur, such as smoking, alcohol, obesity and depression. Furthermore, the ways in which social factors exacerbate the effect of biomedical CVD risk factors among PWH is not well understood. Using a syndemics framework, which is uniquely suited for the evaluation of the clustering of social and biological conditions in vulnerable populations, we will investigate reasons for the persistently high risk of CVD among PWH. With the team’s interdisciplinary expertise in HIV, CVD and syndemics, our study is designed to understand how social, economic and biological factors combine in PWH, contributing to their high CVD risk. We will leverage comprehensive electronic health record (EHR) data from Kaiser Permanente (KP) and detailed existing survey and biospecimen from the KP Research Bank (KPRB). In Aim 1, we will examine synergistic relationships with major adverse cardiovascular events (MACE) among 29,000 PWH and 1:20 matched people without HIV (PWoH) enrolled in KP from 2000-2021. We will evaluate clusters of social and biological factors available in EHRs such as mental health, substance use disorders (SUD), neighborhood deprivation, and insurance benefits. For Aim 2, we will perform a complementary study within the KPRB to identify synergistic relationships with subclinical CVD among 1,969 PWH (709 with biospecimens) and 1:1 matched PWoH. We will consider additional social factors from surveys that may impact CVD risk, including discrimination and stigma, social isolation, emotional and practical health support, and economic factors. Finally, Aim 3 will involve recruitment of 60 PWH from high-risk clusters identified in Aims 1 and 2 for in-depth qualitative interviews to explore how the syndemic conditions contribute to the high CVD risk. The interviews will inform a follow-up survey of 350 PWH recruited from the same high- risk clusters, to confirm syndemic conditions in a larger sample that could be addressed in future CVD prevention efforts. Integrating quantitative and qualitative data sources, this study has great potential to inform future comprehensive community- and health system-level interventions to reduce the CVD burden in PWH.

项目摘要/摘要 抗逆转录病毒疗法（ART）导致患者的发病率和死亡率急剧下降 艾滋病毒（PWH）。但是，随着PWH的年龄，心血管疾病（CVD）的风险增加了，预计 男性的PWH中的终生燃烧为65％，女性为44％。 PWH中观察到的CVD风险较高 与一般人群相比，是既定的CVD风险因素的患病率较高的结果 （吸烟，酒精，血脂异常）以及HIV感染的直接影响，包括免疫缺陷和 炎。最近的研究还实施了整合酶链抑制剂和其他艺术，随着增加的增加 体重可能会进一步增加CVD的风险。也有许多知识的社会和经济学 可能导致PWH高CVD风险的条件，包括医疗保健访问和 治疗，社会隔离，创伤史和艾滋病毒污名。虽然大多数研究都考虑了影响 孤立的CVD危险因素，众所周知，许多经常共发生，例如吸烟，酒精， 肥胖和抑郁。此外，社会因素加剧生物医学CVD的影响的方式 PWH中的风险因素尚不清楚。使用Syndemics框架，它非常适合 评估脆弱人群中社会和生物条件的聚类，我们将调查 PWH中CVD风险持续高的原因。凭借该团队的艾滋病毒跨学科专业知识， CVD和Syndemics，我们的研究旨在了解社会，经济和生物学因素如何结合 在PWH中，有助于其高CVD风险。我们将利用全面的电子健康记录（EHR） 来自Kaiser Permanente（KP）的数据以及KP研究银行的现有调查和生物测量 （kprb）。在AIM 1中，我们将检查与重大不良心血管事件（MACE）的协同关系 在29,000 PWH和1:20中，有2000 - 2021年从KP招收的没有艾滋病毒的人（PWOH）。我们将 评估EHR中可用的社会和生物学因素群，例如精神健康，药物使用 疾病（SUD），邻里剥夺和保险福利。对于AIM 2，我们将执行 在KPRB中进行完全研究，以确定1,969的亚临床CVD的协同关系 PWH（709带有生物测量）和1：1匹配的PWOH。我们将考虑调查的其他社会因素 这可能会影响CVD风险，包括歧视和污名，社会隔离，情感和实际健康 支持和经济因素。最后，AIM 3将涉及高风险群集招募60 PWH 在目标1和2中确定的深入定性访谈，以探讨联合体状况如何贡献 高CVD风险。访谈将为您从同一高级招募的350个PWH的后续调查提供信息。 风险群集，以确认可以在以后的CVD中解决的较大样本中的联合条件 预防努力。整合定量和定性数据源，本研究具有很大的潜力来告知 未来的综合社区和卫生系统级干预措施，以减少PWH中的CVD伯恩。