Pathways from Food Insecurity to Health and Treatment Outcomes in Women with HIV

艾滋病毒携带者从粮食不安全到健康和治疗结果的途径

• 批准号: 8537507
• 负责人: SHERI Dawn WEISER
• 金额: $ 64.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8537507
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Affect; American; Anti-Retroviral Agents; Appointment; Behavior Therapy; Behavioral; Behavioral Sciences; Biometry; Blood Pressure; CD4 Positive T Lymphocytes; Cardiovascular Diseases; Cardiovascular system; Caring; Cell Count; Central obesity; Cessation of life; Clinical Nutrition; Color; Cross-Sectional Studies; Data; Diabetes Mellitus; Diet; Drug abuse; Dyslipidemias; Effectiveness; Food; Food Access; Food Assistance Programs; Funding; General Population; Goals; HIV; HIV Infections; HIV-1; Hair; Health; Health Planning; Heart Diseases; High Density Lipoproteins; Highly Active Antiretroviral Therapy; Household; Hyperlipidemia; Hypertension; Hypertriglyceridemia; Immune; Immunologics; Immunology; Individual; Infectious Disease Immunology; Inflammation; Insulin Resistance; Interruption; Intervention; Journals; Life; Link; Longitudinal Studies; Low income; Low-Density Lipoproteins; Measures; Mediating; Mediator of activation protein; Medicine; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Nutritional; Obesity; Outcome; Participant; Pathway interactions; Persons; Plasma; Probability; Prospective Studies; Publishing; RNA; Recovery; Research; Resources; Risk; Sampling; Socioeconomic Status; Solutions; Stress; Techniques; Testing; Treatment outcome; United States; United States National Institutes of Health; Viremia; Woman; Work; antiretroviral therapy; cardiovascular risk factor; cost; disorder control; fasting plasma glucose; follow-up; food challenge; food quality; food security; glucose metabolism; health disparity; high risk; immune activation; improved; inflammatory marker; lipid metabolism; medical appointment; medical food; men; microbial; mortality; multidisciplinary; novel; nutrition; premature; programs; waist circumference

DESCRIPTION (provided by applicant): HIV-infected women have higher rates of morbidity and mortality compared to men in the United States (U.S.). An important driver of health disparities and worse outcomes among HIV-infected women is food insecurity, or the inability to access food of sufficient quality or quantity in socially acceptable ways. Food insecurity affects 18 million households in the U.S. (40% of low income households), is more prevalent among women, and affects about half of urban poor HIV-infected individuals. Food insecurity is associated with worse immunologic and virologic outcomes in cross-sectional studies, increased HIV-related morbidity and mortality in longitudinal studies, and increased cardiovascular risk factors (hypertension, diabetes, and hyperlipidemia) in cross-sectional studies in the general population. Due to these negative health impacts among HIV-infected individuals, governmental and non-governmental organizations have argued to integrate food security and HIV/AIDS programming activities. A rigorous longitudinal study is urgently needed to quantify the impacts and identify the dominant mechanisms by which food insecurity negatively impacts health in order to improve the effectiveness and reach of food assistance programs and guide their integration with HIV/AIDS programs. The proposed research assembles experts from medicine, infectious disease, immunology, biostatistics, and nutrition for a 4-year longitudinal study to quantify the impacts and identify the pathways linking food insecurity to HIV treatment and cardiovascular health in the Women's Interagency HIV Study (WIHS). WIHS is an ongoing, prospective study in the U.S. of 1500 HIV-infected women and 650 non-infected, but at-risk, women. We plan to leverage the detailed HIV treatment and cardiovascular risk measures collected in WIHS to accomplish 3 aims. In aims 1 and 2, we hypothesize that food insecurity will be associated with worse HIV treatment and cardiovascular risk outcomes and that these relationships will be partially mediated by nutritional (food quality/quantity, obesity), mental health (depression, stress), and behavioral (treatment non-adherence, missed appointments) pathways. To accomplish aims 1 and 2, we will add measures of food insecurity, dietary quality, socio-economic status, competing demands between food and medical care, and antiretroviral (ARV) hair levels (a technique we pioneered as an objective measure of ARV adherence) to WIHS. Our analytic approach will be guided by a novel conceptual model that we recently published in the American Journal of Clinical Nutrition. In aim 3, we hypothesize that food insecurity will be associated with markers of gut microbial translocation (MT), inflammation and immune activation among HIV-infected women, and that this association will be mediated by diet, obesity, and worse HIV control. To accomplish aim 3, we will add measures of gut MT and immune activation for a sub-sample of 250 women on ARV therapy. Our work will be critical to attract funding for this priority issue. The ultimate goal of this work is to develop sustainable solutions to tackle the intersecting challenges of food insecurity and HIV/AIDS morbidity and mortality among women in the U.S.

描述（由申请人提供）：在美国，与男性相比，感染艾滋病毒的女性发病率和死亡率更高。艾滋病毒感染妇女健康差异和更糟糕结果的一个重要驱动因素是粮食不安全，或者无法以社会可接受的方式获得足够质量或数量的粮食。粮食不安全影响着美国 1800 万个家庭（40% 的低收入家庭），在女性中更为普遍，并影响到大约一半的城市贫困艾滋病毒感染者。横断面研究中粮食不安全与较差的免疫学和病毒学结果相关，纵向研究中与艾滋病毒相关的发病率和死亡率增加，以及一般人群横断面研究中心血管危险因素（高血压、糖尿病和高脂血症）的增加。由于艾滋病毒感染者对健康的这些负面影响，政府和非政府组织主张将粮食安全和艾滋病毒/艾滋病规划活动结合起来。迫切需要进行严格的纵向研究来量化其影响并确定粮食不安全对健康产生负面影响的主要机制，以提高粮食援助计划的有效性和范围，并指导其与艾滋病毒/艾滋病计划的整合。 拟议的研究汇集了来自医学、传染病、免疫学、生物统计学和营养学的专家，进行为期 4 年的纵向研究，以量化影响并确定妇女机构间艾滋病毒研究 (WIHS) 中粮食不安全与艾滋病毒治疗和心血管健康之间的联系途径。 WIHS 是一项在美国进行的前瞻性研究，研究对象为 1500 名 HIV 感染女性和 650 名未感染但有风险的女性。我们计划利用 WIHS 中收集的详细艾滋病毒治疗和心血管风险测量来实现 3 个目标。在目标 1 和 2 中，我们假设粮食不安全将与较差的艾滋病毒治疗和心血管风险结果相关，并且这些关系将部分由营养（食品质量/数量、肥胖）、心理健康（抑郁、压力）和行为（不遵守治疗、错过预约）途径。为了实现目标 1 和 2，我们将增加粮食不安全、膳食质量、社会经济地位、食品和医疗保健之间的竞争需求以及抗逆转录病毒 (ARV) 头发水平（我们首创的一项技术，作为抗逆转录病毒治疗依从性的客观衡量指标）的衡量标准) 到 WIHS。我们的分析方法将以我们最近在《美国临床营养学杂志》上发表的新颖概念模型为指导。在目标 3 中，我们假设粮食不安全将与 HIV 感染女性的肠道微生物易位 (MT)、炎症和免疫激活标志物相关，并且这种关联将由饮食、肥胖和 HIV 控制较差介导。为了实现目标 3，我们将为接受 ARV 治疗的 250 名女性的子样本添加肠道 MT 和免疫激活的测量。我们的工作对于为这一优先问题吸引资金至关重要。这项工作的最终目标是制定可持续的解决方案，以应对美国妇女粮食不安全和艾滋病毒/艾滋病发病率和死亡率等交叉挑战。