Multi-Dimensional Successful Aging Among HIV-Infected Adults

艾滋病毒感染者的多维成功老龄化

基本信息

批准号：
9195747
负责人：
DILIP V. JESTE
金额：
$ 64.69万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-01-09 至 2019-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9195747
关键词：
Acquired Immunodeficiency Syndrome Adult Affect Age Aging American Biological Aging Biological Markers C-reactive protein CCL2 gene CD4 Positive T Lymphocytes Cell Count Chronic Clinical Cognitive Cohort Effect Demographic Factors Development Disease F2-Isoprostanes Fibrin fragment D Future Goals HIV Impaired cognition Individual Individual Differences Institutes Insulin Resistance Interleukin-6 Intervention Investigation Laboratories Lead Length Life Expectancy Longitudinal cohort Mediator of activation protein Medical Methodology Modeling National Institute of Mental Health Older Population Outcome Outcome Measure Participant Persons Phonation Physical Function Physically Handicapped Plasma Preventive Intervention Psychological Factors Psychosocial Factor Public Health Quality of life Recruitment Activity Research Research Design Risk Factors Role Severities Severity of illness Spirituality Stress Structure Surveys System TNF gene Telephone Telephone Interviews Therapeutic Intervention Variant Viral Load result Visit Work age effect aged allostatic load antiretroviral therapy base blood-based biomarker cognitive function cohort design follow-up improved improved outcome inflammatory marker interest lifestyle factors longitudinal design neurobehavioral novel optimism programs psychosocial public health relevance resilience social engagement telomere

项目摘要

DESCRIPTION (provided by applicant): The life expectancy of adults receiving antiretroviral therapy (ART) has been increasing progressively. By 2015 one-half of HIV+ people in the U.S. will be over age 50, and this number is expected to continue to rise. While there has been a growing interest in aging with HIV, there is a dearth of research on successful aging with HIV. We define successful aging as a multi-dimensional construct with physical, cognitive, and psychosocial domains, with the downstream outcome being self-perceived successful aging. The proposed study will be the first large-scale investigation examining the relationship of positive psychological factors such as resilience, hardiness, optimism, and social engagement along with laboratory-based systemic markers of biological aging and HIV disease severity to the different domains of successful aging in HIV+ individuals as compared to well- matched Non-HIV-infected Comparison subjects (NCs). Subjects will include 120 HIV+ adults and 90 NCs aged 36-65 years. The biomarkers will include: telomere length, F2-isoprostanes, inflammatory markers (high- sensitivity C-reactive protein, IL-6, d-dimer, TNF-alpha, CCL2, d-dimer and sCD14), insulin resistance, and allostatic load, and, among HIV+ individuals, indicators of HIV disease severity (plasma HIV viral load, CD4+ T-cell count, AIDS/nonAIDS). Participants in each decade (36-45, 46-55, 56-65) will be evaluated using a structured Multi-cohort Longitudinal Design (sMLD), with balanced recruitment providing 40 HIV+ and 30 HIV- subjects per decade. The sMLD enables separation of cohort effects from developmental (within-subject) aging effects, allowing us to estimate aging trajectories across the entire age range of 36-65 years. Subjects will be followed for up to 4 years, with in-person bi-annual visits for detailed assessments, and evaluated with follow- up telephone interviews and mail surveys in the years in which they are not seen in person. We will examine the longitudinal trajectories of clinical outcome measures and positive psychological factors as well as biomarkers of aging and HIV disease, and compare them to those in NC subjects. Our first aim is to determine whether and how trajectories of successful aging differ between HIV+ and NC groups. We will also identify predictors of successful aging trajectories in HIV+ and NC groups. This project is related to NIMH Strategic Objective #2: charting illness trajectories to determine when, where, and how to intervene with HIV+ individuals. This study is novel in its focus on multi-dimensional characterization and recognition of predictors of successful aging in HIV+ adults as well as the use of advanced statistical methodology that allows for the distinction of cohort and developmental aging effects. We anticipate that successful aging trajectories will differ between HIV+ and NC groups suggesting that successful aging paradigms established in non-HIV-infected cannot be simply be generalized to HIV-infected persons. Understanding potentially malleable protective versus risk factors at an individual level may lead to development of new interventions aimed at increasing the likelihood of successful aging among people living with HIV.

描述（由申请人提供）：接受抗逆转录病毒疗法（ART）的成年人的预期寿命一直在逐渐增加。到2015年，美国的艾滋病毒+人中的一半将超过50岁，预计这一数字将继续增加。尽管对艾滋病毒的衰老越来越兴趣，但对与艾滋病毒的成功衰老的研究不足。我们将成功的衰老定义为具有物理，认知和心理社会领域的多维结构，下游结果是自我感知的成功衰老。拟议的研究将是第一个大规模研究，研究了积极的心理因素，例如韧性，顽固，乐观和社交参与，以及与与良好匹配的非HIV受感染比较主题相比，生物衰老和HIV疾病严重程度与HIV+个体成功衰老的不同领域的基于实验室的系统标记（NC）。受试者将包括120名HIV+成人和90名NC，年龄36-65岁。 The biomarkers will include: telomere length, F2-isoprostanes, inflammatory markers (high- sensitivity C-reactive protein, IL-6, d-dimer, TNF-alpha, CCL2, d-dimer and sCD14), insulin resistance, and allostatic load, and, among HIV+ individuals, indicators of HIV disease severity (plasma HIV viral load, CD4+ T-cell计数，艾滋病/非援助）。每十年（36-45、46-55、56-65）的参与者将使用结构化的多核心纵向设计（SMLD）评估，平衡招募每十年提供40个HIV+和30名HIV受试者。 SMLD可以将队列效应与发育（受试者内部）衰老效应分开，从而使我们能够在整个36-65岁之间估算整个年龄范围内的衰老轨迹。受试者最多将进行4年，并进行周期的双年访问，以进行详细评估，并在没有亲自看到的几年中进行了跟进电话访谈和邮件调查。我们将检查临床结局指标和阳性心理因素以及衰老和艾滋病毒疾病的生物标志物，并将其与NC受试者中的患者进行比较。我们的第一个目的是确定HIV+和NC组成功衰老的轨迹是否有所不同。我们还将确定HIV+和NC组成功衰老轨迹的预测指标。该项目与NIMH战略目标＃2：制定疾病轨迹，以确定何时，何处以及如何与HIV+个人进行干预。这项研究是新颖的，重点是多维表征和识别艾滋病毒+成年人成功衰老的预测因素，以及使用先进的统计方法，从而可以区分队列和发展性衰老效应。我们预计，艾滋病毒+和NC组之间的成功衰老轨迹将有所不同，这表明在非HIV感染者中建立的成功衰老范式不能简单地被推广到感染HIV的人。在个人层面上了解潜在的可延展保护性与危险因素可能会导致发展新干预措施，旨在增加艾滋病毒患者成功衰老的可能性。