HIV and Aging: Impact on Cognition and Mortality

艾滋病毒和衰老：对认知和死亡率的影响

• 批准号: 7692915
• 负责人: KARL GOODKIN
• 金额: $ 16.81万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7692915
• 关键词: AIDS Dementia Complex; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Age; Aging; Alcohol or Other Drugs use; Anti-Retroviral Agents; Attention; CD4 Positive T Lymphocytes; CD4/CD8 ratio procedure; CD8-Positive T-Lymphocytes; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Cognition; Cognitive; Cohort Studies; Data; Data Set; Databases; Development; Disease; Disease Progression; Elderly; Fatigue; Frequencies; Future; HIV; HIV-1; Health; Immune; Impaired cognition; Impairment; Individual; Infection; Intervention; Longitudinal Studies; Measures; Medical; Memory; Minor; Moods; Motor Skills; Neurocognitive; Nutritional status; Pain; Patients; Penetration; Performance; Persons; Pharmaceutical Preparations; Plasma; Process; Quality of life; Reporting; Research Design; Risk Factors; Sampling; Staging; Sum; Symptoms; Treatment Protocols; Viral Load result; Visuospatial; Work; alcohol measurement; clinically significant; depressed; executive function; functional status; information processing; mild neurocognitive impairment; mortality; motor disorder; neuropsychological; processing speed; AIDS Dementia Complex; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Age; Aging; Alcohol or Other Drugs use; Anti-Retroviral Agents; Attention; CD4 Positive T Lymphocytes; CD4/CD8 ratio procedure; CD8-Positive T-Lymphocytes; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Cognition; Cognitive; Cohort Studies; Data; Data Set; Databases; Development; Disease; Disease Progression; Elderly; Fatigue; Frequencies; Future; HIV; HIV-1; Health; Immune; Impaired cognition; Impairment; Individual; Infection; Intervention; Longitudinal Studies; Measures; Medical; Memory; Minor; Moods; Motor Skills; Neurocognitive; Nutritional status; Pain; Patients; Penetration; Performance; Persons; Pharmaceutical Preparations; Plasma; Process; Quality of life; Reporting; Research Design; Risk Factors; Sampling; Staging; Sum; Symptoms; Treatment Protocols; Viral Load result; Visuospatial; Work; alcohol measurement; clinically significant; depressed; executive function; functional status; information processing; mild neurocognitive impairment; mortality; motor disorder; neuropsychological; processing speed

DESCRIPTION (provided by applicant): By the year 2015, it is estimated that 50% of HIV-1 infected persons in the US will be 50 or older. HIV-1 affects much the same cognitive processes as those altered by aging, and HIV-1-associated clinical disease progression appears more rapid in older individuals. The longitudinal data from over 20 years in the Multi- Center AIDS Cohort Study (MACS) provides an unparalleled opportunity to examine the relationship of older age to HIV-1-associated cognitive impairment. Our prior work has demonstrated associations between older age and HIV-1-associated neuropsychological performance, symptoms of minor cognitive-motor disorder, immune measures (CD4/CD8 ratio; CD8 cell percentage), and plasma viral load. The overall objective of the proposed MACS database study is to determine whether aging and HIV-1 infection have a synergistic effect on the frequency and rate of the progression of neurocognitive impairment and disorder (MCMD and HAD), pre- and post-HAART. That is, are the effects of both aging and HIV-1 infection on cognition significantly greater than the simple sum of the effects of each factor alone? We plan to create four sub-groups from the MACS sample: older (> 50) and younger (18-39) HIV-1-seropositive and older and younger HIV-1-seronegative individuals. Control variables will include sociodemographic characteristics; antiretroviral medication regimen used (by CNS penetration and adherence); CDC clinical disease stage; CD4 cell nadir; depressed and anxious mood levels; alcohol and psychoactive substance use; prescribed psychotropic medication use; HIV-1- associated physical symptom burden; comorbid medical conditions; pain and fatigue levels; and global nutritional status. We also plan to examine the contribution of the presence of HIV-1-associated neurocognitive impairment and disorder to decreased functional status as well as to increased mortality rates, pre- and post-HAART. A well-controlled examination of the comprehensive and extensive longitudinal MACS study data set could generate new and clinically significant information upon which to guide future clinical interventions to address the needs of this rapidly growing group of HIV-1 infected patients today. Until the late-1990s, older age and HIV-1 infection were thought to be non-overlapping health issues. Between 1996 and 1997, newly reported AIDS cases among older persons increased by 12.6%. By the year 2015, it is estimated that 50% of HIV-1 infected persons in the US will be 50 or older. Older age at onset of AIDS is a risk factor for the occurrence of and the more rapid development of HIV-associated dementia as well as minor cognitive-motor disorder and sub-clinical neurocognitive impairment.

描述（由申请人提供）：到2015年，据估计，在美国，有50％的HIV-1感染者将为50岁以上。 HIV-1影响与衰老改变的认知过程相同，而与HIV-1相关的临床疾病进展似乎更快。多20多年来，多个中心艾滋病队列研究（MAC）的纵向数据提供了一个无与伦比的机会，可以检查老年与HIV-1相关的认知障碍的关系。我们先前的工作表明，年龄与HIV-1相关的神经心理学表现，次要认知运动障碍的症状，免疫测量（CD4/CD8比例； CD8细胞百分比）和血浆病毒负荷之间的关联。拟议的MAC数据库研究的总体目标是确定衰老和HIV-1感染是否对神经认知障碍和混乱的进展（MCMD和HAT），前和后HAART的进展是否具有协同作用。也就是说，衰老和HIV-1感染对认知的影响是否明显大于单独的每个因素的简单总和？我们计划从MAC样本中创建四个子组：较旧（> 50）和较年轻（18-39）HIV-1播阳性以及年龄较大的HIV-1-谐音个体。控制变量将包括社会人口统计学特征；使用的抗逆转录病毒药物治疗方案（通过中枢神经系统穿透和依从性）； CDC临床疾病阶段； CD4细胞nadir;沮丧和焦虑的情绪水平；酒精和精神药物使用；处方精神药物使用； HIV-1-相关的身体症状负担；合并医疗状况；疼痛和疲劳水平；和全球营养状况。我们还计划研究HIV-1相关的神经认知障碍和障碍对降低功能状况以及降低死亡率降低的贡献。对全面且广泛的纵向MAC研究数据集进行了良好的控制检查，可以产生新的和临床上重要的信息，以指导未来的临床干预措施，以满足当今这一快速增长的HIV-1感染患者的需求。直到1990年代末，人们认为年龄较大和HIV-1感染是不重叠的健康问题。在1996年至1997年之间，老年人中新报告的艾滋病病例增加了12.6％。到2015年，据估计，在美国，有50％的HIV-1感染者将为50岁以上。艾滋病发作时的老年年龄是艾滋病毒相关痴呆以及较小的认知运动障碍和次临床神经认知障碍的危险因素。