Developing a Risk Index for Functional Decline in Middle-Aged and Older Adults with HIV

制定中老年艾滋病毒感染者功能衰退的风险指数

• 批准号: 10762280
• 负责人: Lillian Ham
• 金额: $ 4.03万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762280
• 关键词: Acceleration; Acquired Immunodeficiency Syndrome; Address; Adult; Adverse event; Age; Aging; Behavioral; Biological; Buffers; California; Characteristics; Clinical; Clinical Research; Cognition; Cognitive aging; Communities; Community Practice; Complex; Cross-Sectional Studies; Data; Data Set; Dedications; Development; Development Plans; Diabetes Mellitus; Dimensions; Disease; Elderly; Emotional; Exhibits; Fostering; HIV; HIV Seronegativity; HIV antiretroviral; Hyperlipidemia; Incidence; Individual; Intercept; Intervention Studies; Knowledge; Longitudinal Studies; Maintenance; Measures; Medical; Mental Depression; Mentors; Mentorship; Mission; Modeling; NIH Office of AIDS Research; National Institute on Aging; Neurocognitive Deficit; Outcome; Pattern; Persons; Population; Prevention Research; Prevention strategy; Psychological Factors; Public Health; Research; Research Priority; Risk; Role; Sampling; Scientist; Time; Training; Unemployment; Universities; Validation; Variant; Work; adverse outcome; age effect; aging population; antiretroviral therapy; behavior measurement; biopsychosocial factor; burden of illness; career development; clinical practice; comorbidity; disability; experience; functional decline; functional independence; high risk; human old age (65+); improved; indexing; individualized prevention; longitudinal dataset; middle age; neurobehavioral; novel; peer; predictive modeling; preservation; programs; protective factors; psychologic; research and development; skills; social; tool; tool development

PROJECT SUMMARY/ABSTRACT As people with HIV (PWH) enter older adulthood, there is a growing public health need to preserve everyday functioning in aging PWH. PWH disproportionately experience adverse factors including neurocognitive impairment (NCI) and psychiatric (e.g., depression) and medical (e.g., diabetes) comorbidities relative to age- comparable peers without HIV. Together, these factors put older PWH at risk for everyday functioning decline. Despite this, there are few studies on the longer-term patterns and correlates of everyday functioning change in PWH, and there is no well-validated multivariable risk index informed by such longitudinal data. Therefore, the research aims of this F31 will delineate unique longitudinal trajectories of everyday functioning in PWH; and develop and initially validate a risk index of adverse and protective factors based on longitudinal modeling to identify PWH at risk for functional decline. This project will be conducted with support from an interdisciplinary mentorship team at the University of California, San Diego (UCSD) HIV Neurobehavioral Research Program (HNRP), a leading research center with experts in HIV and aging. The proposed F31 will leverage access to two archival longitudinal studies: CNS HIV Antiretroviral Therapy Effects Research (CHARTER; N = 704) and Multi-Dimensional Successful Aging Among HIV-Infected Adults (N = 106), that were conducted and/or coordinated at the HNRP. Accordingly, the specific aims are to: 1) identify unique everyday functioning trajectories in a development dataset (CHARTER); 2a) develop a prediction model using adverse predictors for functional decline in the development dataset; 2b) validate the model in the development (CHARTER) and validation (Successful Aging) datasets; and 3) determine if positive psychological factors add incremental value to predicting functional decline. The training plan proposes rigorous statistical training in developing advanced longitudinal predictive models of everyday functioning, combined with specific mentoring in the understanding and uses of biopsychosocial variables relevant to aging PWH as potential predictors. This F31 application is in line with the National Institute of Aging’s (NIA) mission to support and conduct biological, clinical, behavioral, and social research on aging; in addition to their mission to foster the development of research and clinician scientists in aging. It is also in line with an NIH Office of AIDS Research (OAR) priority for well-validated, multivariable indices that combine a range of biological to behavioral measures to predict which PWH are at high-risk for adverse outcomes. The opportunities afforded via this F31 mechanism will facilitate the applicant’s professional development toward becoming an independent academic neuropsychologist dedicated to promoting successful aging among older PWH.

项目概要/摘要 随着艾滋病毒感染者 (PWH) 进入老年，维护日常生活的公共卫生需求日益增长 老年感染者的功能不成比例地经历包括神经认知在内的不利因素。 与年龄相关的损伤（NCI）以及精神（例如抑郁症）和医学（例如糖尿病）合并症 这些因素共同导致老年感染者面临日常功能下降的风险。 尽管如此，关于日常功能变化的长期模式和相关性的研究却很少 在 PWH 中，并且没有经过充分验证的纵向数据提供的多变量风险指数。 该 F31 的研究目标将描绘 PWH 日常功能的独特纵向轨迹； 并基于纵向模型开发并初步验证不利因素和保护因素的风险指数 以确定有功能衰退风险的感染者 该项目将在一个机构的支持下进行。 加州大学圣地亚哥分校 (UCSD) HIV 神经行为学跨学科指导团队 研究计划 (HNRP)，一个领先的研究中心，拥有艾滋病毒和衰老方面的专家。 利用两项纵向档案研究：中枢神经系统艾滋病毒抗逆转录病毒治疗效果研究 （宪章；N = 704）和艾滋病毒感染成年人的多维成功老龄化（N = 106）， 由 HNRP 进行和/或协调，具体目标是： 1) 确定独特的。 开发数据集中的日常功能轨迹 (CHARTER)；2a) 使用以下方法开发预测模型： 开发数据集中功能衰退的不利预测因素；2b) 验证模型 开发（CHARTER）和验证（成功老化）数据集；以及 3) 确定是否为阳性； 训练计划提出，心理因素可以增加预测功能衰退的价值。 严格的统计培训，开发日常功能的高级纵向预测模型， 结合对与衰老相关的生物心理社会变量的理解和使用的具体指导 PWH 作为潜在的预测因子。该 F31 应用符合国家老龄化研究所 (NIA) 的使命。 除了其使命外，还支持和开展有关衰老的生物学、临床、行为和社会研究； 促进老龄化研究和临床科学家的发展，这也符合美国国立卫生研究院办公室的要求。 艾滋病研究 (OAR) 优先考虑经过充分验证的多变量指数，这些指数结合了一系列生物和 行为测量来预测哪些 PWH 面临不良后果的高风险。 通过这个F31机制将促进申请人的专业发展，成为一名 独立学术神经心理学家，致力于促进老年 PWH 成功老龄化。