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.

项目概要/摘要 联合抗逆转录病毒疗法（ART）已导致患有以下疾病的人的发病率和死亡率急剧下降 HIV (PWH)。然而，随着 PWH 年龄的增长，心血管疾病 (CVD) 的风险也会增加，预计 男性 PWH 的终生负担为 65%，女性为 44% 观察到的 PWH CVD 风险较高。 与一般人群相比，这是由于已确定的 CVD 危险因素的患病率较高 （吸烟、饮酒、血脂异常）以及艾滋病毒感染的直接影响，包括免疫缺陷和 最近的研究还表明整合酶链抑制剂和其他 ART 会增加炎症。 体重，这可能会进一步增加心血管疾病的风险，还有许多尚未得到充分研究的社会和经济因素。 可能导致感染者出现高 CVD 风险的条件，包括医疗保健获取和治疗方面的差异 虽然大多数研究都考虑了其影响。 尽管单独列出 CVD 危险因素，但众所周知，许多因素经常同时发生，例如吸烟、酗酒、 此外，社会因素加剧生物医学心血管疾病的影响。 感染者中的危险因素尚未得到充分了解。使用特别适合的流行病框架。 评估弱势群体的社会和生物条件的聚类，我们将调查 凭借该团队在艾滋病毒方面的跨学科专业知识， CVD 和综合症，我们的研究旨在了解社会、经济和生物因素如何结合起来 在 PWH 中，我们将利用全面的电子健康记录 (EHR)。 来自 Kaiser Permanente (KP) 的数据以及来自 KP 研究银行的详细现有调查和生物样本 (KPRB)。在目标 1 中，我们将研究与主要不良心血管事件 (MACE) 的协同关系。 我们将在 2000 年至 2021 年间参加 KP 的 29,000 名 PWH 和 1:20 匹配的无艾滋病毒感染者 (PWoH) 中进行调查。 评估电子病历中可用的社会和生物因素集群，例如心理健康、药物使用 对于目标 2，我们将执行一项任务。 KPRB 内的补充研究，旨在确定 1,969 名患者与亚临床 CVD 的协同关系 PWH（709 个生物样本）和 1:1 匹配的 PWoH 我们将考虑调查中的其他社会因素。 可能影响心血管疾病风险的因素，包括歧视和耻辱、社会孤立、情感和实际健康 最后，目标 3 将涉及从高风险人群中招募 60 名感染者。 目标 1 和 2 中确定的深入定性访谈，以探讨综合症条件如何发挥作用 这些访谈将为从同一高风险地区招募的 350 名感染者进行后续调查提供信息。 风险集群，以确认更大样本中的综合征状况，这些症状可以在未来的 CVD 中得到解决 这项研究整合了定量和定性数据源，具有巨大的指导意义。 未来综合社区和卫生系统层面的干预措施，以减少感染者的心血管疾病负担。