Mechanisms of Disparities in Adverse Neurocognitive Outcomes among Hispanics Aging with HIV

感染艾滋病毒的西班牙裔老龄化不良神经认知结果差异的机制

• 批准号: 9901363
• 负责人: Maria Marquine
• 金额: $ 68.67万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901363
• 关键词: Accounting; Adopted; Age; Aging; Attenuated; Automobile Driving; Behavioral; Bioinformatics; Biological Factors; Biological Process; Blood - brain barrier anatomy; Brain; Communities; Consequences of HIV; Cross-Sectional Studies; Data; Dementia; Development; Diet; Disadvantaged; Discipline; Disease Progression; Ensure; Environment; Environmental Risk Factor; Ethnic Origin; Fibrinogen; Geography; HIV; HIV Infections; Health; Healthcare; Hispanics; Information Systems; Institutes; Intervention; Intestinal permeability; K-Series Research Career Programs; Knowledge; Latino; Lead; Link; Longevity; Longitudinal observational study; Mediating; Medicine; Metabolic syndrome; Nature; Neuraxis; Neurocognitive; Neurocognitive Deficit; Neuropsychology; Not Hispanic or Latino; Outcome; Patient Recruitments; Persons; Physical activity; Population; Public Health; Race; Research; Risk; Severities; United States; adverse outcome; aged; antiretroviral therapy; community based participatory research; community clinic; community partnership; comorbidity; comparison group; dysbiosis; ethnic disparity; gut microbiome; health disparity; health literacy; high risk; improved; interdisciplinary approach; medication nonadherence; microbiome research; mild cognitive impairment; minority health; multidisciplinary; neurobehavioral; prevent; programs; public health priorities; racial and ethnic; social culture; success

PROJECT SUMMARY The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent despite highly effective antiretroviral therapy, with approximately 40% of persons living with HIV showing neurocognitive impairment (NCI). Compared to other ethnic/racial groups in the United States, HIV infected (HIV+) Hispanics/Latinos/as, hereafter referred to as Hispanics, present with increased risk for NCI and neurocognitive decline; and this risk is particularly pronounced in older age. Yet, the factors underlying these disparities are not well understood. Guided by the National Institute of Minority Health and Health Disparities Research Framework, the present proposal aims to identify key mechanisms underlying adverse neurocognitive outcomes among Hispanics aging with HIV. Among the potential predictors of NCI in this group, the proposed study will focus on two biological processes -- metabolic syndrome and gut microbiome dysbiosis -- that may be particularly problematic among Hispanics and may result in greater brain vulnerability to HIV. The study will also integrate aspects of the physical/built and sociocultural environment (assessed via geocoding) that have been linked to metabolic syndrome and NCI, and investigate their influence on neurocognitive disparities in HIV. We will also explore the impact of behavioral (physical activity and diet) and healthcare (healthcare use and access, health literacy) variables. We will collect these data in 200 HIV+ and HIV-uninfected Hispanics (approximately half Spanish-speaking) aged 40 and over, and investigate their impact on neurocognitive status cross-sectionally and longitudinally over the course of three years. We will leverage existing longitudinal data from the UCSD HIV Neurobehavioral Research Program to select a comparison group of 100 HIV+ non-Hispanic Whites. To ensure the success of the proposed multidisciplinary approach, we have assembled a research team representing an integration of relevant disciplines, including cross-cultural neuropsychology, health disparities, medicine, public health, microbiomics, geography, and bioinformatics, and information systems. Recognizing the importance of a community-based participatory research approach in the study of health disparities, we have partnered with community clinics and stakeholders whose input has helped strengthen our approach and assure its relevance to the community. We will build on existing cross-sectional studies in Hispanics led by the PI for recruitment of participants into the proposed study, and our community partnerships will help assure that we reach the most vulnerable segments of the Hispanic community. With this multidisciplinary and community integrated approach to research, we aim to increase our understanding of the complexity that underlies mechanisms of disparities in neurocognitive outcomes among diverse groups of Hispanics aging with HIV. Such knowledge is crucial for the development of targeted, culturally relevant interventions to prevent or ameliorate HIV-associated NCI among Hispanics and reduce health disparities.

项目摘要 艾滋病毒和相关合并症对中枢神经系统的不利后果仍然很普遍 尽管高效的抗逆转录病毒疗法，大约40％的艾滋病毒患者显示 神经认知障碍（NCI）。与美国其他种族/种族群体相比，艾滋病毒感染了 （HIV+）西班牙裔/拉丁美洲人/AS，以下称为西班牙裔，存在NCI和 神经认知能力下降；这种风险在老年时尤其明显。然而，这些因素是这些因素 差异不太了解。在美国国家少数民族健康与健康差异的指导下 研究框架，本提案旨在确定不利的关键机制 与艾滋病毒衰老的西班牙裔衰老之间的神经认知结果。在该组NCI的潜在预测因素中， 拟议的研究将重点介绍两个生物学过程 - 代谢综合征和肠道微生物组营养不良 - 在西班牙裔中，这可能尤其有问题，并且可能导致更大的大脑脆弱性艾滋病毒。 该研究还将整合物理/建筑和社会文化环境的各个方面（通过 与代谢综合征和NCI有关的地理编码），并研究了它们对 艾滋病毒中的神经认知差异。我们还将探讨行为（体育锻炼和饮食）和 医疗保健（医疗保健使用和访问，健康素养）变量。我们将在200 HIV+和 艾滋病毒未感染的西班牙裔（大约一半的西班牙语）年龄在40岁以上，并调查他们的 在三年的时间里，对神经认知状况的影响在横截面和纵向上。我们将 利用UCSD HIV神经行为研究计划中的现有纵向数据选择 100 HIV+非西班牙裔白人的比较组。确保拟议的多学科的成功 方法，我们组建了一个研究团队，代表相关学科的整合，包括 跨文化神经心理学，健康差异，医学，公共卫生，微生物学，地理和 生物信息学和信息系统。认识到基于社区的参与者的重要性 研究方法在研究健康差异方面，我们与社区诊所合作 投入的利益相关者有助于加强我们的方法并确保其与社区的相关性。我们 将以PI领导的西班牙裔横断面研究为基础 拟议的研究以及我们的社区伙伴关系将有助于确保我们达到最脆弱的细分市场 西班牙裔社区。通过这种多学科和社区综合研究方法，我们的目标 为了增加我们对神经认知差异机制基础的复杂性的理解 与艾滋病毒的西班牙裔衰老群体之间的结果。这样的知识对于发展至关重要 针对性的，具有文化相关的干预措施，以预防或改善西班牙裔与与HIV相关的NCI和 减少健康差异。