An EYE toward healthy aging in HIV: building evidence for multimorbidity screening and prevention

关注艾滋病毒健康老龄化：为多病筛查和预防建立证据

基本信息

批准号：
10762829
负责人：
Lauren Frances Collins
金额：
$ 17.82万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-15 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10762829
关键词：
Address Affect Age Aging Albuminuria Alzheimer&apos s Disease Angiography Award Biological Markers Biometry Blood Pressure Blood Vessels Bone Diseases CD8B1 gene Cardiovascular Diseases Chronic Chronic Disease Clinic Clinical Clinical Practice Guideline Cognitive Cohort Studies Cross-Sectional Studies Data Development Development Plans Diabetes Mellitus Disease Early Intervention Elements Enrollment Epidemiologist Epidemiology Evolution Fostering Funding Gender General Population Geroscience Glycosylated hemoglobin A Goals HIV HIV Seronegativity Health Healthcare Individual Inflammation Inflammatory Intervention Life Life Expectancy Longevity Longitudinal Studies Low-Density Lipoproteins Measures Mediating Mediator Mentors Methods Modeling Modernization Modification Optical Coherence Tomography Organ Participant Patient Recruitments Pattern Persons Population Postmenopausal Osteoporosis Premature Mortality Prevention Primary Care Process Public Health Quality of life Research Research Infrastructure Research Methodology Research Personnel Research Project Grants Retina Risk Risk Assessment Risk Factors Science Scientist Sentinel Survival Analysis Techniques Testing Time Training Translating Universities Vascular Diseases Viremia Woman Women&apos s Health Work aged care delivery care outcomes career career development clinical development cohort collaborative environment comorbidity cost density design early onset experience follow-up health care service utilization healthy aging high risk innovation longitudinal, prospective study men multiple chronic conditions non-invasive imaging novel patient oriented peer pre-clinical premature progression marker public health intervention retinal imaging risk sharing screening sex sociodemographics tool translational physician translational scientist trend

项目摘要

PROJECT SUMMARY Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is an emergent global threat to individual and public health as populations age. While the average life expectancy for a person with HIV has reached 77 years, comorbidity-free years are ~16 fewer than the general population. Not only are aging-related, chronic comorbidities more common in HIV, but onset is up to a decade earlier and women are disproportionately affected. Despite the impact of multimorbidity—reduced quality of life, higher healthcare utilization and cost, and premature mortality—being magnified among persons with HIV, current HIV Primary Care Guidance does not specifically address multimorbidity, and screening and prevention tools are lacking. In the MACS/WIHS Combined Cohort Study (MWCCS), an aging cohort of >12,000 persons with or at-risk of HIV with >35 years of follow-up, we showed that aging-related comorbidity burden was significantly higher in women than in men, particularly in persons with HIV. We also found that multimorbidity risk in treated persons with HIV was mediated by both traditional and HIV-related factors. This patient-oriented career development application builds on our prior work, and will use a geroscience-guided approach for optimizing care delivery and outcomes for aging women and men with HIV at risk of premature multimorbidity across the lifespan. The overarching conceptual framework prioritizes the study of the aging process as it affects multiple (as opposed to singular) comorbidities and how these comorbid conditions cluster and have shared risk factors, causal mechanisms, and/or impacts. The proposed Aims include: 1) To ascertain the age-specific evolution of multimorbidity cascades; 2) To identify multimorbidity clusters and shared risk factors; and 3) To determine if microvascular indicators predict the progression of multimorbidity status. My long-term career goal is to become an independently-funded clinician-scientist whose work is focused on: 1) ascertaining multimorbidity risk and impact across the lifespan of persons with HIV, and 2) translating these findings into sex-tailored clinical and public health interventions that promote healthy aging. During this Award, I will be mentored by Dr. Igho Ofotokun, a translational researcher in HIV end-organ damage; Dr. Anandi Sheth, an HIV implementation scientist with expertise in women’s health; Dr. Solveig Cunningham, a chronic disease epidemiologist; Dr. Leah Rubin, a neuroscientist focused on cognitive health patterns and predictors; and Dr. Camille Vaughan, a geriatrician-clinical trialist with interventions expertise. Completion of the outlined research Aims and the proposed training in geroscience research methods, advanced epidemiology and biostatistics including latent class analysis and other cluster analytic techniques, and sex/gender health will significantly enhance my ability to achieve my career goals to become an independent researcher in HIV comorbidity science and women’s health. Emory University offers an ideal collaborative environment and provides robust research infrastructure to complete the proposed career development plans and mentored research project outlined in this application.

项目概要多重病，即同一个人同时存在两种或多种慢性病，是一种新兴的全球性问题随着人口老龄化，个人和公共健康受到威胁，而人的平均预期寿命则下降。艾滋病毒感染者年龄已达 77 岁，无合并症年龄比一般人群少约 16 岁。与衰老相关的慢性合并症在艾滋病毒中更为常见，但发病时间要早十年，而且女性发病时间更早尽管存在多种疾病的影响——生活质量下降，但医疗保健水平提高。利用和成本以及过早死亡——在艾滋病毒感染者中被放大，目前艾滋病毒主要护理指南没有专门解决多重疾病，并且缺乏筛查和预防工具。 MACS/WIHS 联合队列研究 (MWCCS)，这是一个由超过 12,000 名患有或有风险的老年人组成的队列经过超过 35 年的随访，我们发现与衰老相关的合并症负担显着更高女性多于男性，特别是艾滋病毒感染者，我们还发现接受治疗的人存在多种疾病的风险。这种以患者为导向的职业发展是由传统因素和艾滋病相关因素介导的。该应用程序建立在我们之前的工作基础上，并将使用老年科学引导的方法来优化护理服务以及感染艾滋病毒的老年女性和男性在一生中面临过早罹患多种疾病的风险的结果。总体概念框架优先考虑衰老过程的研究，因为它影响多种（而不是到单数）合并症以及这些合并症如何聚集并具有共同的风险因素、因果关系拟议的目标包括： 1) 确定年龄特定的演变。多重发病级联；2) 确定多重发病集群和共同风险因素；以及 3) 确定是否微血管指标预测多种疾病状态的进展我的长期职业目标是成为一名独立资助的临床医生科学家，其工作重点是：1）确定多种疾病 HIV 感染者一生中的风险和影响，以及 2) 将这些发现转化为针对性别的定制方案在这个奖项期间，我将得到促进健康老龄化的临床和公共卫生干预措施。 Igho Ofotokun，HIV 终末器官损伤领域的转化研究员；Anandi Sheth 博士，HIV 实施者；具有女性健康专业知识的科学家；Solveig Cunningham 博士，慢性病流行病学家 Leah 博士；鲁宾（Rubin）是一位专注于认知健康模式和预测因素的神经科学家；卡米尔·沃恩（Camille Vaughan）博士是一位神经科学家。老年病学临床试验师进行干预措施完成概述的研究目标和任务。拟议的老年科学研究方法、高级流行病学和生物统计学（包括潜在疾病）培训类别分析和其他聚类分析技术，以及性别/性别健康将显着提高我的能力实现我的职业目标，成为艾滋病毒合并症科学和女性问题的独立研究员埃默里大学提供理想的协作环境并提供强大的研究基础设施。完成本申请中概述的拟议职业发展计划和指导研究项目。