Challenging and Expanding Paradigms of Aging with HIV

挑战和扩展艾滋病毒老龄化范式

• 批准号: 8071870
• 负责人: Keri Nicole Althoff
• 金额: $ 13.26万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-08 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8071870
• 关键词: Acquired Immunodeficiency Syndrome; Address; Age; Age-Years; Aging; American; Anti-Retroviral Agents; Area; Automobile Driving; Biological; CD4 Lymphocyte Count; CD4 Positive T Lymphocytes; Calendar; Canada; Cells; Cessation of life; Characteristics; Clinical; Clinical Practice Guideline; Cohort Studies; Collaborations; Communication; Comorbidity; Computer software; Consultations; Country; Data; Data Collection; Diagnosis; Disease; Education; Elderly; End stage renal failure; Enrollment; Ensure; Environment; Epidemiologic Methods; Epidemiologic Studies; Epidemiologist; Epidemiology; Ethnic Origin; Evaluation; Event; Exposure to; Foundations; Funding; General Population; Generations; Geographic Locations; Goals; HIV; HIV Infections; Health Policy; Hepatitis C; Highly Active Antiretroviral Therapy; Hypertension; Immune system; Incidence; Individual; Infection; Instruction; Intention; Investigation; Justice; K-Series Research Career Programs; Kidney Diseases; Life; Malignant Neoplasms; Manuscripts; Mentors; Mentorship; Methodology; Methods; Morbidity - disease rate; Morphologic artifacts; Myocardial Infarction; Observational Study; Oral; Outcome; Participant; Patients; Pharmaceutical Preparations; Population; Population Attributable Risks; Population Study; Positioning Attribute; Preparation; Prevalence; Preventive Intervention; Principal Investigator; Process; Productivity; Protease Inhibitor; Public Health; Public Health Practice; Public Health Schools; Publications; Race; Regimen; Renal carcinoma; Research; Research Design; Research Personnel; Resources; Risk; Risk Factors; Role; Sample Size; Screening procedure; Smoking; Structural Models; Time; Training; United States; Veterans; age related; aged; antiretroviral therapy; base; career; clinical care; clinical practice; cohort; comparison group; effective therapy; high risk; interest; male; medical schools; meetings; multidisciplinary; sex; statistics; symposium

DESCRIPTION (provided by applicant): The overall goal of this application is to support the education and research endeavors of the investigator, who has the intention of developing a career as an independent investigator of observational epidemiologic research focused on age-related comorbidities (i.e. myocardial infarction [MI], end-stage renal disease [ESRD] and non-AIDS related cancers [cancer]) in HIV-infected individuals. To-date, the candidate has received excellent doctoral training in HIV and epidemiologic methods; she has begun focusing research interests on comorbidities among individuals aging with HIV infection. The career development award allows for five years of didactic and scientific training to establish a career as an independent research investigator via the following mechanisms:1) direct mentorship in research question generation, study design, statistical analysis, interpretation of findings, scientific communication and manuscript preparation from expert HIV epidemiologist Dr. Stephen Gange (mentor) and aging with HIV expert clinician and researcher Dr. Kelly Gebo (co-mentor) through weekly meetings, semi-annual goals evaluation, and productivity tracking using document sharing software; 2) consultation from Dr. Amy Justice, Principal Investigator (PI) of the Veterans Aging Cohort Study (VACS) and expert in aging with HIV clinician and epidemiologist, Dr. Richard Moore, PI of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and expert HIV clinician and researcher, and Dr. Cynthia Boyd, gerontologist and leader in research of multimorbidity in older adults; 3) obtaining formal instruction in aging epidemiology, the mechanism of aging in disease processes and causal inference methods at the Johns Hopkins Bloomberg School of Public Health (JHSPH); 4) implementing the proposed research in the data-rich environment of VACS and NA-ACCORD studies; 4) utilizing the resource-rich environments of the Statistics in Epidemiology (STATEPI) research group, and the Department of Epidemiology, JHSPH, and the Johns Hopkins School of Medicine (JHSOM). Immediate, short-term and longer-term career goals include increasing productivity to at least five publications and one oral presentation at a scientific conference each calendar year, successfully competing for R01 funding for studies investigating multimorbidity in aging HIV-infected individuals by 2016, and achieving a productive career as an independent research investigator, respectively. It is estimated =50% of people living with HIV in the US in 2015 will be aged =50 years. The overall aim of the proposed research is to challenge and expand upon paradigms in aging with HIV research by investigating three questions of clinical and public health significance: 1) Do HIV-infected individuals have a higher risk of comorbidities compared to sociodemographically similar HIV-uninfected individuals? 2) Are traditional or HIV- related risk factors driving the increased risk of comorbidities in HIV-infected individuals? 3) What is the impact of the timing of highly active antiretroviral therapy (HAART) initiation on the risk of comorbidities? These questions will be asked by investigating the following aims: Aim 1: To estimate the difference in risk of comorbidities in HIV-infected and similar -uninfected individuals in the US in clinical care, by age at comorbidity diagnosis. Aim 2: To determine the attributable fraction of traditional and HIV-related risk factors on comorbidities in HIV-infected individuals in clinical care in the US and Canada. Aim 3: To determine the risk of first comorbid event after HAART initiation by CD4 count at HAART initiation in HIV-infected individuals in clinical care in the US and Canada. The Veteran's Aging Cohort Study (VACS) is a longitudinal, multisite observational study of >100,000 HIV- infected and similar -uninfected patients with the aim of evaluating age-related comorbidites in HIV-infected individuals, making it an ideal cohort to investigate Aim 1. Although the generalizability of the findings from this predominantly male cohort may be restricted, the HIV-infected and -uninfected individuals were matched by age, race and ethnicity, sex and geographical location, ensuring strong internal validity to investigate the HIV effect. The NA-ACCORD is a longitudinal, multisite observational study of HIV-infected individuals, enrolling >115,000 HIV-infected participants with data collection efforts underway for MI, ESRD, and cancer events. This collaboration of cohorts is uniquely positioned to address Aims 2 and 3 with a sample size large enough to capture an adequate number of comorbid events. The 1) data-rich environments of the VACS and the NA- ACCORD, 2) resource-rich environments of STATEPI, the Department of Epidemiology and the JHSOM, and 3) assembled multidisciplinary team of mentors and consultants allows for the investigation of these aims, that challenge and expand upon current paradigms in aging with HIV, to serve as the candidate's foundation for a successful career as an independent research investigator.

DESCRIPTION (provided by applicant): The overall goal of this application is to support the education and research endeavors of the investigator, who has the intention of developing a career as an independent investigator of observational epidemiologic research focused on age-related comorbidities (i.e. myocardial infarction [MI], end-stage renal disease [ESRD] and non-AIDS related cancers [cancer]) in HIV-infected individuals.迄今为止，候选人接受了艾滋病毒和流行病学方法的出色博士培训。她已经开始将研究兴趣集中在患有艾滋病毒感染的个体中的合并症上。职业发展奖允许五年的教学和科学培训通过以下机制建立独立研究研究者的职业：1）研究问题生成，研究设计，统计分析，发现的解释，研究结果的解释，科学沟通和手稿的直接指导，来自专家HIV Expidemiologger to a gange and agent a gange（Mentor）和研究专家kelly geying（Co-kelly geying selly Geying selly ge-kelly ge-kelly keelly kelly selly seveling kelly sellying kelly sellying sellying kelly keelly kelly selly selly in）（使用文档共享软件进行半年度目标评估和生产力跟踪； 2）退伍军人衰老队列研究（VAC）的首席研究员（PI）的咨询，与HIV临床医生和流行病学家，北美艾滋病研究与研究和研究人员研究员和研究员研究员和研究员的北美PI合作的Richard Moore博士，北美艾滋病研究员和研究员的北美PI合作的磋商 成年人; 3）在约翰·霍普金斯彭博公共卫生学院（JHSPH）获得疾病过程中衰老的衰老机制和因果推理方法的正式教学； 4）在VAC和NA-ACCORD研究的数据丰富的环境中实施拟议的研究； 4）利用流行病学（StatePI）研究小组中统计数据的资源丰富的环境以及流行病学系JHSPH和JOHNS HOPKINS医学院（JHSOM）。即时，短期和长期职业目标包括在每个日历年的一次科学会议上提高至少五个出版物的生产率，并在2016年成功地竞争了R01资金的研究，以研究研究艾滋病毒感染者在2016年，并分别作为一项独立研究研究员的富有成效的职业。 估计= 2015年美国艾滋病毒感染者中有50％的年龄= 50岁。拟议研究的总体目的是通过调查临床和公共卫生意义的三个问题来挑战和扩展艾滋病毒研究衰老的范例：1）与社会人口统计学上类似的艾滋病毒无关的人相比，受HIV感染者的合并症风险更高？ 2）传统或与HIV相关的风险因素是否推动了感染HIV感染者合并症的风险增加？ 3）高度活跃的抗逆转录病毒疗法（HAART）开始对合并症的风险有什么影响？这些问题将通过调查以下目的提出：目标1：估计在美国临床护理中，在美国临床护理中，在合并症诊断时，在美国，艾滋病毒感染和类似未感染的个体的合并症风险差异。目标2：确定美国和加拿大临床护理中艾滋病毒感染者合并症的传统和HIV相关风险因素的可归因比例。 AIM 3：确定在HAART在美国和加拿大，在HAART启动HAART启动HAART启动HAART启动后首次合并事件的风险。 这位退伍军人的老化队列研究（VACS）是一项纵向的多站点观察性研究，对> 100,000名受HIV感染和类似未感染的患者，其目的是评估与年龄相关的HIV感染者中与HIV感染的人相关的人，这是一个理想的人群，尽管这是一个理想的人群。个人与年龄，种族和种族，性别和地理位置相匹配，以确保强烈的内部有效性来研究艾滋病毒效应。 NA-Accord是一项纵向，多站点观察性研究的艾滋病毒感染者，在MI，ESRD和癌症事件的数据收集工作中招收> 115,000名HIV感染的参与者。这种队列的这种合作是独特的定位，可以解决目标2和3，其样本量足以捕获足够数量的合并事件。 1）VAC和NA-ACCORD的数据丰富的环境，2）Statepi的资源丰富的环境，流行病学和JHSOM和JHSOM，以及3）组装的多学科导师和顾问团队允许对这些目标进行调查，这些目标，这些挑战和扩展与HIV的挑战和扩展有关HIV的研究，以作为HIV的研究，以使其作为候选人的奠基统治者的职业生涯，以实现构建的奠基工作。