Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation Study (BEEHIVE)

巴尔的摩口腔流行病学、疾病影响和 HIV 评估研究 (BEEHIVE)

• 批准号: 10668433
• 负责人: Gregory D Kirk
• 金额: $ 91.04万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668433
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Affect; African American population; Age; Aging; Baltimore; Biological; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Disease; Clinical; Communities; Dental Care; Dental Epidemiology; Dentists; Diabetes Mellitus; Diagnostic; Dimensions; Disease; Disease Management; Disease Marker; Disease Progression; Disparity; Epidemiologist; Epidemiology; Evaluation Studies; Funding; Future; HIV; HIV Infections; HIV Seronegativity; HIV therapy; Health Status; Healthcare; Heart Diseases; High Prevalence; Immunosuppression; Individual; Inflammatory; Intervention; Interview; Intravenous; Investigation; Joints; Kidney; Life Expectancy; Life Style; Link; Liver; Low income; Lung; Medical Records; Metabolic; Methods; Morbidity - disease rate; Mouth Diseases; Mucous Membrane; Neurocognitive; Oral; Oral health; Organ; Patient Self-Report; Pattern; Periodontal Diseases; Periodontitis; Periodontium; Persons; Pharmaceutical Preparations; Phenotype; Phylogenetic Analysis; Physicians; Population; Populations at Risk; Prevalence; Principal Component Analysis; Recording of previous events; Registries; Research; Research Personnel; Risk Behaviors; Risk Factors; Salivary; Severities; System; Therapeutic Intervention; Time; United States; United States National Institutes of Health; Viral; Viremia; Visit; age related; aged; antiretroviral therapy; bone; care seeking; clinical examination; cohort; comorbidity; disability; experience; health care service; health literacy; insight; lifestyle factors; longitudinal analysis; metabolomics; metaproteomics; metatranscriptomics; microbiome; microbiome composition; microbiome signature; modifiable risk; mortality; multidisciplinary; novel; oral microbiome; prognostic; retention rate; social; systemic inflammatory response

Since the advent of antiretroviral therapy (ART), the life expectancy of persons living with HIV (PLWH) has steadily increased in the United States. PLWH are now more likely to develop co-morbid age-related non- communicable diseases (NCDs) than are similarly-aged HIV-uninfected persons, and the morbidity and mortality of NCD and age-related conditions is paramount. The age-adjusted rates of multiple NCDs are higher among PLWH than among persons who are HIV negative. In addition, PLWH experience higher prevalence and severity of oral diseases, particularly related to the periodontium, although the factors that explain these disparities remain unclear. For example, is HIV-related immune suppression or viremia primarily responsible for these differences? Are lifestyle factors and access to dental care important determinants? Is the microbiome signature in PLWH unique and does it change over time? Since 1988, the AIDS Linked to the Intravenous Experience (ALIVE) study has successfully followed a lower-income, predominantly African American population of HIV-infected and at-risk persons with a history of injecting drugs (PWID) in a community-based cohort in Baltimore. Over three decades, ALIVE has characterized risk factors of incident HIV and progression to AIDS or death, described patterns of risk behaviors, identified barriers to optimal HIV care, and provided important insights into the natural and treated course of HIV among PWID. In recent years, ALIVE has transitioned to exploring the impact of aging with HIV, focusing on phenotypes and organ-specific non-communicable diseases (NCD) (e.g., liver, lung, cardiovascular, bone, kidney, neurocognitive and metabolic NCDs). The proposed project leverages the ALIVE platform to focus on the combined effects of HIV and NCDs on oral health at the health care-seeking, clinical, and microbiological levels. The specific aims of the proposed project are to: 1) determine to what extent HIV status influences access to and utilization of oral health care services; 2) determine to what extent HIV status affects self-reported and clinical oral health status; 3) determine to what extent HIV status influences the progression of periodontitis; and 4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. The first three specific aims include sub-aims that define the extent to which comorbid NCDs act as effect modifiers. For specific aim 4, one sub-aim describes the extent to which HIV influences the oral microbiome and a second sub-aim defines how longitudinal changes in the oral microbiome signature affect periodontitis progression. To achieve these aims, we build upon biannual ALIVE study visits with interview, clinical examination, and biospecimen components, supplemented by medical record review and registry linkages. The key impact of these aims is to illuminate social and individual-level mechanisms, identify modifiable risk factors, and produce novel insights to inform efficient and targeted oral health interventions for PLWH in Baltimore and nationally.

自抗逆转录病毒疗法（ART）出现以来，艾滋病毒（PLWH）的人的预期寿命 美国稳步增长。现在，PLWH更有可能发展与年龄相关的非 - 与类似的艾滋病毒未感染的人以及发病率和发病率相似的传染病（NCD） NCD的死亡率和与年龄相关的条件至关重要。多个NCD的年龄调整率较高 在PLWH中，艾滋病毒负面的人比在PLWH中。此外，PLWH经历了更高的患病率 口腔疾病的严重程度，特别是与牙周有关的，尽管解释这些因素的因素 差异仍然不清楚。例如，是HIV相关的免疫抑制或主要负责的病毒血症 对于这些差异？生活方式因素和获得牙科护理的机会是否重要的​​决定因素？是 PLWH中的微生物组签名独特，它会随着时间而变化吗？自1988年以来，艾滋病与 静脉经历（活着）的研究成功遵循了低收入，主要是非洲人 美国艾滋病毒感染者和高危人群注射药物的史（PWID） 巴尔的摩基于社区的队列。三十年来，活着的事件危险因素的特征 艾滋病毒和艾滋病或死亡的进展，描述的风险行为模式，确定了最佳艾滋病毒的障碍 护理，并为PWID中的自然和治疗艾滋病毒的自然和治疗过程提供了重要的见解。最近几年， Alive已过渡到探索艾滋病毒衰老的影响，重点是表型和特定器官 非传染性疾病（NCD）（例如肝脏，肺，心血管，骨骼，肾脏，神经认知和 代谢NCD）。拟议的项目利用活着的平台专注于艾滋病毒的综合作用 以及关于寻求医疗保健，临床和微生物学水平的口腔健康的NCD。具体目的 拟议的项目是：1）确定艾滋病毒状况在多大程度上影响口服的访问和利用 卫生保健服务； 2）确定艾滋病毒状况在多大程度上影响自我报告和临床口腔健康状况； 3）确定艾滋病毒状况在多大程度上影响牙周炎的进展； 4）确定什么 HIV状态影响与牙周炎相关的口腔微生物组签名。前三个特定目标 包括定义合并NCD作为效应修饰符的程度的子iams。对于特定目标4，一个 Sub-aim描述了艾滋病毒影响口腔微生物组的程度，第二个子aim定义了如何 口腔微生物组特征的纵向变化会影响牙周炎进展。为了实现这些目标， 我们以访谈，临床检查和生物测量成分进行双年度活着的研究来访问， 补充病历审查和注册表链接。这些目的的关键影响是阐明 社会和个人水平机制，确定可修改的风险因素，并产生新颖的见解以告知 在巴尔的摩和全国范围内，PLWH的有效且有针对性的口腔健康干预措施。