Cardiovascular, Pulmonary and Hematological Disease in HIV: Prevention and Treatment

HIV 引起的心血管、肺部和血液疾病：预防和治疗

• 批准号: 8915890
• 负责人: Heidi M. Crane
• 金额: $ 79.94万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8915890
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Affect; Age; Aging; Alcohol or Other Drugs use; Alcohols; Anemia; Anti-Retroviral Agents; Bayesian Modeling; Behavior; Behavioral; Blood; CD4 Lymphocyte Count; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Clinical; Clinical Data; Coagulation Process; Cohort Studies; Collection; Complex; Data; Data Sources; Deep Vein Thrombosis; Demographic Aging; Detection; Development; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Drug usage; Epidemic; Epithelial; Face; Frequencies; Functional disorder; Glucose; HIV; HIV Infections; Health; Health Services Accessibility; Health behavior; Healthcare; Heart; Heart Diseases; Hematological Disease; Illicit Drugs; Immunologics; Incidence; Infection; Inflammation; Intervention; Investigation; Knowledge; Laboratories; Life; Location; Lung; Lung diseases; Measures; Minority; Modeling; Modification; Morbidity - disease rate; Myocardial Infarction; Names; Outcome; Patient Outcomes Assessments; Pattern; Persons; Pharmaceutical Preparations; Physical activity; Pneumonia; Polypharmacy; Population; Population Heterogeneity; Prevalence; Prevention; Prevention strategy; Psychosocial Factor; Pulmonary Embolism; Research; Research Infrastructure; Resources; Risk; Risk Factors; Sample Size; Sampling; Site; Smoking; Social Behavior; System; Test Result; Therapeutic Intervention; Thromboembolism; Time; Tobacco; Toxic effect; United States; Venous; Veterans; Viral; Viral Load result; Viremia; Virus Diseases; Woman; antiretroviral therapy; biobank; clinical decision-making; cohort; disorder risk; experience; frailty; health care service utilization; health related quality of life; improved; indexing; inflammatory marker; instrument; modifiable risk; monocyte; mortality; multidisciplinary; novel; prognostic; therapeutic target; treatment strategy; trend

 DESCRIPTION (provided by applicant): The population of people living with HIV (PLWH) in the US are aging; it is projected that by 2015 more than half of US PLWH will be over age 50. Heart, lung, and blood diseases are common among aging PLWH, likely due to a complex interplay of HIV infection itself and resulting inflammation, antiretroviral treatments and their toxicities, viral co-infections, other co-morbid conditions, traditional risk factors such as tobaco, and other behaviors such as substance use. We propose to rigorously assess risk factors associated with increased prevalence and incidence of myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), venous thromboembolism (VTE), and chronic anemia among PLWH, and to determine risk factors associated with poor outcomes from these conditions. Understanding the contribution of multiple factors to the increased risk of disease is crucial to developing strategies to improve prevention, diagnosis, and treatment of these major heart, lung and blood diseases in PLWH. This application leverages comprehensive clinical data and biorepository samples from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS), a data source specifically suggested in the RFA. This large, diverse, well-characterized multi-site cohort captures longitudinal clinical data, patient reported outcomes such as physical activity and substance use, and biospecimens facilitating a nuanced and detailed approach to addressing risk. In addition, CNICS infrastructure allows outcomes to be carefully reviewed and validated capturing key distinctions such as MI type (STEMI vs. non-STEMI) and DVT location. Our multidisciplinary team is uniquely poised to leverage these resources to address important gaps in understanding the pathophysiology, diagnosis, treatment, and impact of MI, COPD, VTE and anemia in PLWH by pursuing 3 aims. Aim 1 is to determine the prevalence and incidence of MI, COPD, VTE and anemia in PLWH, as well as their traditional and HIV-specific risk factors. Aim 2 is to determine risk factors for complicatios and poor outcomes from these four conditions in PLWH. Specific outcomes will include mortality, multi-morbidity, health-related quality of life, frailty, and polypharmacy. Aim 3 is to determine immunologic predictors of MI, COPD, VTE and anemia among PLWH, focusing on soluble markers of inflammation, coagulation, monocyte activation, and gut epithelial integrity. These investigations can identify novel targets for therapeutic interventions. New knowledge gained from these investigations will inform clinical decision making and will dramatically improve understanding of the mechanisms of heart, lung, and blood diseases in PLWH, which in turn will enhance the development of rational and targeted therapeutic approaches to improve outcomes.

 描述（由申请人提供）：美国艾滋病毒感染者 (PLWH) 人口正在老龄化；预计到 2015 年，超过一半的美国艾滋病毒感染者将超过 50 岁。心脏、肺和血液疾病很常见在老年感染者中，可能是由于艾滋病毒感染本身及其引起的炎症、抗逆转录病毒治疗及其毒性、病毒合并感染、其他共病状况、传统危险因素等复杂的相互作用所致我们建议严格评估与感染者、慢性阻塞性肺病（COPD）、静脉血栓栓塞（VTE）和慢性贫血患病率和发病率增加相关的危险因素。并确定与这些疾病不良结果相关的风险因素，对于制定改善这些主要心脏、肺和血液疾病的预防、诊断和治疗的策略至关重要。该应用程序利用来自艾滋病研究中心网络综合临床系统 (CNICS) 的综合临床数据和生物样本库，这是 RFA 中特别建议的一个数据源，该数据源捕获了纵向临床数据。数据、患者报告的结果（例如身体活动和物质使用）以及生物样本，有助于采取细致入微的方法来解决风险。此外，CNICS 基础设施允许仔细审查和验证结果，捕获 MI 类型等关键区别。 （STEMI 与非 STEMI）和 DVT 定位 我们的多学科团队独特地准备利用这些资源，通过追求 3 个目标来解决理解 MI、COPD、VTE 和贫血对 PLWH 的病理生理学、诊断、治疗和影响方面的重要差距。目标 1 是确定 PLWH 中 MI、COPD、VTE 和贫血的患病率和发病率，以及其传统风险因素和 HIV 特异性风险因素。 PLWH 中这四种情况的并发症和不良结果包括死亡率、多种发病率、健康相关的生活质量、虚弱和多药治疗。目标 3 是确定 PLWH 中 MI、COPD、VTE 和贫血的免疫预测因子。 ，重点关注炎症、凝血、单核细胞活化和肠道上皮完整性的可溶性标志物，这些研究可以确定治疗干预的新目标，从这些研究中获得的新知识将为临床决策和治疗提供信息。将极大地提高对感染者的心脏、肺和血液疾病机制的了解，进而促进合理和有针对性的治疗方法的开发，以改善结果。