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

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）：预计到 2015 年，美国 50% 的 HIV-1 感染者将年龄在 50 岁或以上。 HIV-1 影响的认知过程与衰老改变的认知过程大致相同，并且 HIV-1 相关的临床疾病进展在老年人中似乎更快。多中心艾滋病队列研究 (MACS) 20 多年来的纵向数据为研究老年与 HIV-1 相关认知障碍之间的关系提供了无与伦比的机会。我们之前的工作已经证明，老年与 HIV-1 相关的神经心理表现、轻微认知运动障碍症状、免疫指标（CD4/CD8 比率；CD8 细胞百分比）和血浆病毒载量之间存在关联。拟议的 MACS 数据库研究的总体目标是确定衰老和 HIV-1 感染是否对 HAART 前后神经认知障碍和疾病（MCMD 和 HAD）进展的频率和速率具有协同作用。也就是说，衰老和 HIV-1 感染对认知的影响是否显着大于每个因素单独影响的简单总和？我们计划从 MACS 样本中创建四个亚组：老年 (> 50) 和年轻 (18-39) HIV-1 血清阳性个体以及老年和年轻 HIV-1 血清阴性个体。控制变量将包括社会人口特征；使用的抗逆转录病毒药物治疗方案（通过中枢神经系统渗透和依从性）； CDC临床疾病阶段； CD4细胞最低点；抑郁和焦虑的情绪水平；酒精和精神活性物质的使用；使用处方精神药物； HIV-1 相关的身体症状负担；合并症；疼痛和疲劳程度；和全球营养状况。我们还计划研究在HAART之前和之后HIV-1相关的神经认知障碍和障碍对功能状态下降以及死亡率增加的影响。对全面且广泛的纵向 MACS 研究数据集进行良好控制的检查可以产生新的具有临床意义的信息，以此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 感染患者群体的需求。直到 20 世纪 90 年代末，老龄化和 HIV-1 感染都被认为是不重叠的健康问题。 1996年至1997年间，新报告的老年人艾滋病病例增加了12.6%。到 2015 年，预计美国 50% 的 HIV-1 感染者将年龄在 50 岁或以上。艾滋病发病年龄较大是艾滋病毒相关痴呆以及轻微认知运动障碍和亚临床神经认知障碍发生和更快发展的危险因素。