URBAN ARCH (5/5) Boston Cohort - Alcohol and HIV-associated comorbidity and complications: Frailty, Functional impairment, Falls, and Fractures (the 4F study)

URBAN ARCH (5/5) 波士顿队列 - 酒精和 HIV 相关合并症和并发症：虚弱、功能障碍、跌倒和骨折（4F 研究）

• 批准号: 9545618
• 负责人: RICHARD SAITZ
• 金额: $ 65.33万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9545618
• 关键词: AIDS/HIV problem; Accident and Emergency department; Acute; Address; Affect; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Body Weight decreased; Boston; Cessation of life; Clinical; Cohort Studies; Collaborations; Comorbidity; Complication; Development; Disease; Drug usage; Elderly; Emergency department visit; Fall prevention; Fracture; HIV; HIV Infections; HIV risk; Hepatitis C co-infection; High Prevalence; Hospitalization; Illicit Drugs; Impairment; Inflammation; Injury; Intervention; Intervention Studies; Knowledge; Lead; Mediating; Mediation; Morbidity - disease rate; Nature; Neuropathy; Opioid; Osteopenia; Osteoporosis; Osteoporotic; Outcome; Pharmaceutical Preparations; Phenotype; Physical Function; Play; Polypharmacy; Population; Premature aging syndrome; Preventive Intervention; Recovery; Research; Research Priority; Risk; Risk Factors; Role; Russia; Substance Use Disorder; Testing; Translating; Uganda; United States National Institutes of Health; Viremia; Walking; alcohol and other drug; alcohol consequences; alcohol exposure; alcohol research; antiretroviral therapy; base; cohort; cost; exhaustion; experience; fall risk; falls; frailty; functional disability; grasp; health care service utilization; high risk; illicit drug use; improved outcome; inflammatory marker; microbial; middle age; mortality; prevent; systematic review; therapy development; virology; AIDS/HIV problem; Accident and Emergency department; Acute; Address; Affect; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Body Weight decreased; Boston; Cessation of life; Clinical; Cohort Studies; Collaborations; Comorbidity; Complication; Development; Disease; Drug usage; Elderly; Emergency department visit; Fall prevention; Fracture; HIV; HIV Infections; HIV risk; Hepatitis C co-infection; High Prevalence; Hospitalization; Illicit Drugs; Impairment; Inflammation; Injury; Intervention; Intervention Studies; Knowledge; Lead; Mediating; Mediation; Morbidity - disease rate; Nature; Neuropathy; Opioid; Osteopenia; Osteoporosis; Osteoporotic; Outcome; Pharmaceutical Preparations; Phenotype; Physical Function; Play; Polypharmacy; Population; Premature aging syndrome; Preventive Intervention; Recovery; Research; Research Priority; Risk; Risk Factors; Role; Russia; Substance Use Disorder; Testing; Translating; Uganda; United States National Institutes of Health; Viremia; Walking; alcohol and other drug; alcohol consequences; alcohol exposure; alcohol research; antiretroviral therapy; base; cohort; cost; exhaustion; experience; fall risk; falls; frailty; functional disability; grasp; health care service utilization; high risk; illicit drug use; improved outcome; inflammatory marker; microbial; middle age; mortality; prevent; systematic review; therapy development; virology

Up to a third of middle-aged people living with HIV infection (PLWH) experience falls each year. Falls are the most common cause of non-fatal injury in the US and the cost from emergency department visits and hospitalizations are enormous. PLWH are more susceptible to falls and their serious consequences because 1) despite control of HIV viremia, inflammation persists and underlies HIV-associated comorbidities and complications that occur at a relatively young age (so-called premature aging), 2) specific comorbidities (e.g. neuropathy, osteoporosis) and complications (e.g. frailty and impaired physical function) make falls more likely and recovery from them more difficult, 3) alcohol use exacerbates inflammation, and may increase risk for comorbidities and complications, and 4) alcohol use, illicit drug use and polypharmacy can increase the likelihood of a fall. Despite this, fall prevention has not been extensively studied among PLWH. We need interventions to address falls in PLWH but none have been tailored for this population. Understanding risk factors and targets for intervention among PLWH are essential; cohort studies can provide the information needed for intervention development. This proposal is part the Consortia for HIV/AIDS and Alcohol-Related Research Trials (CHAART). It describes the continuation and expansion of a cohort that is one of three in the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH). The URBAN ARCH theme is to address consequences of alcohol use on HIV-associated comorbidities and complications to increase treatment availability and improve outcomes. In line with that theme we propose to continue to follow and expand (to 400) an existing cohort of PLWH and a high prevalence of exposure to alcohol, illicit drugs, and polypharmacy (the Boston ARCH Cohort) in the Frailty, Functional impairment, Falls, and Fractures (4F study) to: (in 2 Primary Aims) 1) Test the associations between alcohol (and illicit drugs and polypharmacy) and falls (fractures secondarily); and 2) Test the associations between alcohol (and illicit drugs and polypharmacy) and acute healthcare utilization (emergency department use and hospitalization for falls and fractures). We will also examine the role frailty plays in these associations between alcohol, drugs and medications and the aforementioned clinical and utilization outcomes. In Exploratory Aims we will test associations between alcohol use and inflammatory markers, and between markers and HIV-associated complication outcomes (4Fs); and develop and pilot test the feasibility of a falls prevention intervention tailored to address the identified risk factors (e.g. alcohol, illicit drugs, polypharmacy) in this population. By achieving these aims we will gain substantially greater understanding of these comorbidities and complications in PLWH exposed to alcohol and other psychoactive substances; this knowledge will serve to inform the development of ways to identify, prevent and manage falls, fractures, frailty and functional impairment.

每年有三分之一的中年中年人（PLWH）经历。瀑布是 美国非致命伤害的最常见原因以及急诊室访问的费用和 住院是巨大的。 PLWH更容易受到跌倒及其严重后果的影响，因为1） 尽管控制了艾滋病毒病毒血症，但炎症仍然存在并依靠艾滋病毒相关的合并症和基础 在相对年轻的年龄（所谓的过早衰老）中发生的并发症，2）特定的合并症（例如 神经病变，骨质疏松症）和并发症（例如身体素质和身体功能受损）使跌倒更多 可能和从他们那里恢复更加困难，3）饮酒会加剧炎症，并可能增加风险 对于合并症和并发症，以及4）饮酒，非法吸毒和多药可以增加 跌倒的可能性。尽管如此，尚未在PLWH中进行广泛研究。我们需要 解决PLWH的干预措施，但没有针对该人群量身定制。了解风险 PLWH中干预的因素和目标至关重要；队列研究可以提供信息 干预开发所需。 该提案是HIV/AIDS和与酒精有关的研究试验（CHAART）的联盟的一部分。它 描述了乌干达俄罗斯饮酒的三个队列的延续和扩展 艾滋病毒/艾滋病（Urban Arch）的酒精研究合作网络。城市拱门主题是 解决饮酒对艾滋病毒相关的合并症和并发症的后果以增加治疗 可用性和改善结果。与这个主题一致，我们建议继续遵循和扩展（到 400）现有的PLWH队列以及暴露于酒精，非法药物和多药的较高流行率 （波士顿拱门队列）在脆弱的，功能障碍，跌倒和骨折（4F研究）中 目的）1）测试酒精（和非法药物和多药）与跌落（骨折）之间的关联 其次）； 2）测试酒精（以及非法药物和多药）与急性之间的关联 医疗保健利用（急诊室使用和跌落和骨折的住院）。我们也会 检查酒精，药物和药物之间的这些关联中脆弱的作用 上述临床和利用结果。在探索目的中，我们将测试 酒精使用和炎症标记，以及标记和与HIV相关的并发症结果之间 （4fs）;并开发和试验测试量身定制的瀑布预防干预措施的可行性 确定了该人群中确定的危险因素（例如酒精，非法药物，多药剂）。通过实现这些目标我们 将对这些合并症和PLWH中的并发症的理解大大了解 酒精和其他精神活性物质；这些知识将有助于开发方式 识别，预防和管理跌倒，断裂，脆弱和功能障碍。