Unpacking the Mechanisms of Disparities for HIV-related Hypertension in African American and Asian Pacific American MSM

揭示非裔美国人和亚太裔 MSM 中 HIV 相关高血压差异的机制

• 批准号: 9912001
• 负责人: GRACE X. MA
• 金额: $ 66.42万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9912001
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; African American; American; Asian Americans; Asians; Behavior; Behavioral; Bisexual; Blood Pressure; CCL2 gene; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Cities; Clinical; Color; Coronary Artery Risk Development in Young Adults Study; Data; Diagnosis; Discrimination; Disease Progression; Epidemic; Etiology; Exposure to; Fibrin fragment D; Gays; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; Health; Homophobia; Hypertension; IL8 gene; Immune; Individual; Inflammation; Inflammatory; Interleukin-6; Knowledge; Life; Literature; Longitudinal observational study; Measures; Mediating; Medicine; Modeling; Native Hawaiian; Outcome; P-Selectin; Pacific Island Americans; Philadelphia; Population; Positioning Attribute; Poverty; Prevalence; Psychosocial Factor; Research; Risk; Risk Factors; Science; Social isolation; Social support; Stress; Testing; Time; United States; Ursidae Family; age group; aged; cohort; comorbidity; coping; cytokine; ethnic discrimination; ethnic minority population; experience; health disparity; interdisciplinary approach; longitudinal design; male; men; men who have sex with men; men' s group; metropolitan; minority health; multidisciplinary; novel; protective factors; racial and ethnic; racial discrimination; racism; sex; social; social determinants; social factors; substance misuse; surveillance data; tool; AIDS prevention; AIDS/HIV problem; Address; Adult; African American; American; Asian Americans; Asians; Behavior; Behavioral; Bisexual; Blood Pressure; CCL2 gene; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Cities; Clinical; Color; Coronary Artery Risk Development in Young Adults Study; Data; Diagnosis; Discrimination; Disease Progression; Epidemic; Etiology; Exposure to; Fibrin fragment D; Gays; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; Health; Homophobia; Hypertension; IL8 gene; Immune; Individual; Inflammation; Inflammatory; Interleukin-6; Knowledge; Life; Literature; Longitudinal observational study; Measures; Mediating; Medicine; Modeling; Native Hawaiian; Outcome; P-Selectin; Pacific Island Americans; Philadelphia; Population; Positioning Attribute; Poverty; Prevalence; Psychosocial Factor; Research; Risk; Risk Factors; Science; Social isolation; Social support; Stress; Testing; Time; United States; Ursidae Family; age group; aged; cohort; comorbidity; coping; cytokine; ethnic discrimination; ethnic minority population; experience; health disparity; interdisciplinary approach; longitudinal design; male; men; men who have sex with men; men' s group; metropolitan; minority health; multidisciplinary; novel; protective factors; racial and ethnic; racial discrimination; racism; sex; social; social determinants; social factors; substance misuse; surveillance data; tool

The literature reveals that hypertension (HTN) is considerably higher among HIV-positive individuals than HIV-negative individuals. However, the systemic/individual determinants (including behavioral, clinical, macro- social, and psychosocial factors) for this health co-morbidity is not fully understood in the literature. To fill these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD’s “Minority Health and Health Disparities Research Framework” -- to examine and elucidate the multiple determinants of HTN observed in two ethnic-sexual men who have sex with men (MSM) living with HIV/AIDS. To that end, we will address three specific aims and hypotheses: Aim 1: To examine the association of macro-social determinants (i.e., homophobia, racial/ethnic discrimination), behavioral risk factors (e.g., substance misuse), and psychosocial factors (e.g., stress) with HTN among a cohort of African American or AA (200 AA in Philadelphia) and Asian Pacific Americans or APA (200 APA in Honolulu) MSM living with HIV -- We hypothesize that greater exposure to homophobia and racial/ethnic discrimination is associated with a greater prevalence of HTN among HIV-positive MSM. Aim 2: To determine the underlying systemic/individual determinants which account for the relationship between inflammation and HTN over time, given common forms of hypertension have been postulated to be immune mediated -- We hypothesize that the greater exposure to homophobia and racial/ethnic discrimination is associated with dysregulation of pro-inflammatory cytokines (D-dimer, hsCRP, IL-6, IL-8, MCP-1, P-selectin), where they mediate HTN among these men. Aims 3: To examine whether associations between these factors and health outcomes are moderated by coping and social support -- We hypothesize that greater social support would mitigate HTN among these men. This is the first study that uses systemic/individual and multi-disciplinary approaches to examine the impact of multiple determinants on HTN co-morbidity over time among AA and APA MSM living with HIV. Our multi-disciplinary team with expertise in HIV prevention science, clinical HIV medicine, ethnic-sexual MSM, and chronic diseases are uniquely positioned to address risk and protective factors of multiple influences of HTN co-morbidity over time among AA and APA MSM with HIV. By conceptually and empirically testing novel hypotheses, we will provide evidence of etiology and validated tools and measures that advance our understanding of mechanisms of disparities in HIV-related co-morbidities. Findings from this longitudinal observational study will inform the management of HIV and its HTN co-morbidity as a chronic disease, especially among the two disparity groups of MSM (AA and APA) who continue to bear the burden of health disparities. This study is guided by NIMHD’s conceptual framework to address multiple influences of health disparities on HTN comorbidity among HIV-positive MSM disparity populations.

文献表明，艾滋病毒阳性个体中的高血压（HTN）比 艾滋病毒阴性个体。但是，全身/单个决定者（包括行为，临床，宏观 - 在文献中尚未完全理解这种健康合并​​症的社会和社会心理因素）。填充 这些科学的差距，我们建议使用纵向设计系统地检查系统/个体 方法 - 在NIMHD的“少数族裔健康与健康差异研究框架”之后进行建模 - 检查并阐明了两个与性关系的族裔男性中观察到的HTN的多个决定者 男性（MSM）患有艾滋病毒/艾滋病。为此，我们将解决三个特定目标和假设：目标1： 检查宏观社会决定者的关联（即同性恋恐惧症，种族/种族歧视）， 行为风险因素（例如，滥用物质）和与HTN的社会心理因素（例如，压力） 非洲裔美国人或AA的队列（费城200 AA）和亚洲太平洋美国人或APA（200 APA 檀香山）MSM患有艾滋病毒的MSM - 我们假设更大的同性恋恐惧症和种族/种族暴露 歧视与HIV阳性MSM之间的HTN患病率更大有关。目标2：确定 基础的系统/个人决定者说明了炎症与 随着时间的流逝，HTN鉴于高血压的常见形式已被认为是免疫介导的 - 我们 假设更大的同性恋恐惧症和种族/种族歧视与 促炎细胞因子（D-Dimer，HSCRP，IL-6，IL-8，MCP-1，p-链染料）的失调，其中它们 在这些男人中调节HTN。目的3：检查这些因素与健康之间的关联是否 应对和社会支持可以调节成果 - 我们假设更大的社会支持将 这些男人中的HTN减轻了HTN。这是第一个使用全身/个人和多学科的研究 检验多个决定者对随着时间的AA和AA和 APA MSM患有艾滋病毒。我们具有艾滋病毒预防科学专业知识的多学科团队，临床艾滋病毒 医学，二个人MSM和慢性疾病的独特位置可以解决风险和保护性 HTN与HIV的AA和APA MSM之间合并的多种影响因素。经过 从概念上和经验测试新的假设，我们将提供病因和验证工具的证据 以及衡量我们对与HIV相关的合并症中分布机制的理解的衡量。 这项纵向观察性研究的发现将为艾滋病毒及其HTN合并症的管理提供信息 作为一种慢性疾病，尤其是在MSM的两个差异组（AA和APA）中，他们继续承受 健康分布的伯宁。这项研究以NIMHD的概念框架为指导 健康差异对HIV阳性MSM差异人群中HTN合并症的影响。