Health Outcomes around Pregnancy and Exposure to HIV/ARV (HOPE): Extending the Reach of PHACS to Examine Women's Health

围绕怀孕和接触 HIV/ARV 的健康结果 (HOPE)：扩大 PHACS 的范围以检查女性健康

• 批准号: 10249082
• 负责人: Ellen Gould Chadwick
• 金额: $ 295.71万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10249082
• 关键词: 18 year old; Address; Adherence; Adolescent; Affect; Age; Anti-Retroviral Agents; Area; Attention; Birth; Caring; Child; Child Health; Child Rearing; Child Support; Clinical; Consequences of HIV; Data; Data Collection; Diagnosis; Disclosure; Disease; Disease Progression; Enrollment; Ensure; Epigenetic Process; Exposure to; Foundations; Future; Genetic; Geography; HIV; HIV Infections; HIV antiretroviral; Health; Health Status; Heterosexuals; Inflammatory; Infrastructure; Institution; Life Cycle Stages; Link; Longevity; Maternal Health; Mental Depression; Mental Health; Methods; Monitor; Morbidity - disease rate; Mothers; Newly Diagnosed; Nulliparity; Opioid; Oral health; Outcome; Participant; Pattern; Patterns of Care; Pediatric HIV/AIDS Cohort Study; Perinatal; Persons; Population; Positioning Attribute; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Prevalence; Proteome; Protocols documentation; Public Health; Puerto Rico; Reproductive Health; Research; Research Design; Research Infrastructure; Resources; Site; Social support; Time; Treatment Factor; Treatment-related toxicity; United States; Viral; Viral Load result; Virus; Woman; Women' s Health; antenatal; antiretroviral therapy; biobank; caregiving; clinical care; co-infection; cohort; comorbidity; cost effective; epidemiology study; follow-up; immune activation; innovation; interest; maternal outcome; microbiome; multidisciplinary; older women; physical conditioning; postpartum care; pregnant; prenatal exposure; prepregnancy; prospective; psychosocial; racism; recruit; reproductive; social stigma; substance use; therapy adherence; transmission process; virome; young woman

Abstract Over 250,000 women in the United States are living with HIV, but limited research has addressed the physical and mental health outcomes among younger women living with HIV (WLHIV). Because health status in the reproductive years and surrounding pregnancy critically affects lifelong health, understanding health outcomes among young WLHIV of reproductive age before, during, and after pregnancy is of substantial public health importance in the US and worldwide. The maternal outcomes of WLHIV are inextricably linked to the long-term health and survival of their children. The Pediatric HIV/AIDS Cohort Study (PHACS), conducted at 21 sites across the US and Puerto Rico, has been following young WLHIV of reproductive age and their children since 2007, with over 2000 birth mothers and >2800 HIV-exposed uninfected (HEU) children. Mothers with perinatally acquired HIV (PHIV) are of specific interest, and the PHACS network includes >400 such women with PHIV (WPHIV) along with their 251 HEU children. Utilizing the successful and longstanding PHACS research infrastructure and existing cohorts, we will establish the Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) cohort, a cohort of 2000 pregnant, non-pregnant or nulliparous WLHIV of reproductive age from geographically diverse, high HIV prevalence areas. Leveraging PHACS, cost-effective and targeted enrollment and follow-up for longitudinal data collection will be achieved; we will also establish a rich biorepository which links WLHIV to their children’s data and biospecimens. Thus, the HOPE research platform will support high impact scientific studies central to the health of young WLHIV. Our scientific aims for the HOPE cohort are: (1) to evaluate the effects of HIV-related disease and treatment factors on reproductive health, non-communicable diseases, and oral health of WLHIV as well as psychosocial determinants of these health outcomes (engagement in care, mental health diagnoses, racism, inequity and stigma, disclosure of HIV, and substance use/misuse), and (2) To assess child health outcomes and their impact on the health of WLHIV, including maternal HIV disease progression, antiretroviral therapy (ART) adherence, engagement in care and maternal mental health. Overall, HOPE will create a platform to explore the multilevel determinants and mechanisms that influence the short and longer-term health of WLHIV during their reproductive years, as well as the health of their children, and will serve as a resource for future multidisciplinary studies in areas such as genetics and epigenetics, microbiome/virome/proteomes and immune activation, to provide better understanding of potential inflammatory and epigenetic processes associated with these outcomes.

抽象的 在美国，有25万名妇女患有艾滋病毒，但有限的研究已经解决了身体 以及艾滋病毒（WLHIV）的年轻妇女的心理健康成果。因为健康状况 生殖年及周围的怀孕严重影响终生健康，了解健康结果 在怀孕之前，期间和之后的生殖年龄的年轻WLHIV中，有很大的公共卫生 在美国和全球的重要性。 WLHIV的产妇结局与长期有着千丝万缕的联系 孩子的健康和生存。小儿艾滋病毒/艾滋病队列研究（PHACS），在21个地点进行 自2007年以来，美国和波多黎各的生殖年龄及其子女一直关注 有2000多名出生母亲和> 2800 HIV暴露的未感染（HEU）儿童。母亲患有围产期 获得的艾滋病毒（PHIV）具有特定的兴趣，PHACS网络包括> 400名此类pHIV女性 （WPHIV）以及他们的251个HEU孩子。利用成功且长期以来的PHACS研究 基础设施和现有队列，我们​​将建立怀孕和暴露的健康状况 到艾滋病毒/抗逆转录病毒（HOPE）队列，2000年的孕妇，非怀孕或无效的wlhiv 来自地理上的高级艾滋病毒流行地区的生殖年龄。利用PHAC，具有成本效益 将实现纵向数据收集的目标注册和随访；我们还将建立一个 丰富的生物座位将WLHIV与孩子的数据和生物测量联系起来。那，希望研究 平台将支持对年轻WLHIV健康核心的高影响科学研究。 我们的科学目标是希望队列：（1）评估与HIV相关疾病和治疗的影响 生殖健康，非通信疾病和WLHIV的口腔健康以及社会心理因素 这些健康结果的决定因素（参与护理，心理健康诊断，种族主义，不平等和 污名，艾滋病毒的披露和药物使用/失误），以及（2）评估儿童健康结果及其影响 关于WLHIV的健康，包括母体HIV疾病进展，抗逆转录病毒疗法（ART）依从性， 参与护理和母性心理健康。总体而言，希望将创建一个平台来探索多级 在生殖过程中影响WLHIV短期健康的决定因素和机制 多年以及孩子的健康，并将作为未来多学科研究的资源 遗传学和表观遗传学，微生物组/病毒蛋白/蛋白质组和免疫激活等领域，以提供更好的 了解与这些结果相关的潜在炎症和表观遗传过程。