HIV, Depression, and Cardiovascular Risk

艾滋病毒、抑郁症和心血管风险

• 批准号: 8929009
• 负责人: MATTHEW S FREIBERG
• 金额: $ 73.07万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-19 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8929009
• 关键词: Address; Adult; Aging; Anti-Retroviral Agents; Antidepressive Agents; Biological Markers; C-reactive protein; Cardiovascular Diseases; Cessation of life; Chronic; Clinical Trials; Coagulation Process; Code; Cognitive Therapy; Cohort Studies; Comorbidity; Data; Depressed mood; Depressive disorder; Development; Diagnostic; Etiology; Event; Exposure to; Fibrin fragment D; Future; General Population; Goals; HIV; HIV Infections; HIV-1; Health; Incidence; Indiana; Individual; Inflammation; Inflammatory; Interdisciplinary Study; Interleukin-6; Intervention; Intervention Trial; Knowledge; Major Depressive Disorder; Measures; Mediating; Mental Depression; Morbidity - disease rate; Myocardial Infarction; Observational Study; Pathway interactions; Patients; Persons; Pharmacologic Substance; Prevention strategy; Primary Prevention; Psychotherapy; Publishing; Questionnaires; RNA; Randomized; Research; Resources; Risk; Risk Factors; Risk Reduction; Severities; Source; Testing; Universities; Up-Regulation; Veterans; antiretroviral therapy; brachial artery; cardiovascular disorder risk; cardiovascular risk factor; cohort; collaborative care; depressed patient; depressive symptoms; endothelial dysfunction; follow-up; high risk; improved; innovation; meetings; mortality; novel; pilot trial; prevent; programs; public health relevance; tool; treatment as usual; treatment program; week trial

 DESCRIPTION (provided by applicant): Despite the improved survival with antiretroviral therapy (ART), HIV-infected patients still remain at higher risk for chronic comorbidities, including cardiovascular disease (HIV-CVD). Elevated circulating levels of interleukin-6 (IL-6), hsCRP, and D-dimer are associated with increased risks of HIV-CVD. In addition, endothelial dysfunction also appears to be common in ART-treated, HIV-infected patients. However, ART only partially lowers these inflammatory and coagulation biomarkers and only partially improves endothelial function as measured by flow-mediated dilation (FMD) of the brachial artery. One potential explanation for the continued heightened risk of HIV-CVD despite ART that has thus far been completely ignored is depression. Because depressive disorders are found in 20-40% of HIV-infected patients receiving ART, it stands to reason that this common comorbidity may contribute to the persistently elevated risk of CVD in HIV. The central objective of this application is to determine the relationships between depressive disorders and its treatments with systemic inflammation/coagulation and endothelial function in HIV-infected persons. We will address this objective with the following Specific Aims: Specific Aim #1: To determine the associations of depression and exposure to depression treatment with systemic inflammation and altered coagulation in HIV. We will conduct an observational analysis of the large (N=1525) Veterans Aging Cohort Study (VACS) Biomarker Cohort which also includes Patient Health Questionnaire (PHQ)-9 scores, extensive pharmaceutical prescription data, and diagnostic codes for depression and psychotherapy; Specific Aim #2: To determine the effects of cognitive behavioral treatment on systemic inflammation, altered coagulation, and endothelial dysfunction in HIV-infected adults with depression. We will address this aim by conducting a pilot, randomized, 24-week trial using the Beating the Blues cognitive behavioral treatment program in 110 ART-treated patients at Indiana University with suppressed HIV-1 RNA levels and with PHQ-9 defined major depression. Our multidisciplinary research team has the required expertise and resources to successfully address these Aims. The results of these studies will determine the relationships between depression, depression treatment, inflammation/coagulation, and endothelial function in HIV-infected patients by leveraging an existing HIV-CVD cohort and by performing a novel, interventional, pilot trial. As such, this application meets the stated objectives of RFA HL-14-023 and will provide the rationale for future interventional trials to reduce HIV-CVD events by treating depression. This line of research may provide HIV clinicians with novel and easily implementable tools to prevent CVD morbidity and mortality in their patients and will advance the field of HIV- CVD research.

 描述（由适用提供）：尽管抗逆转录病毒疗法（ART）的生存率提高，但感染HIV的患者仍处于慢性合并症（包括心血管疾病（HIV-CVD））的风险更高。白介素6（IL-6），HSCRP和D-二聚体的循环水平升高与HIV-CVD风险增加有关。此外，内皮功能障碍在经过艺术治疗的，感染的HIV感染患者中似乎也很常见。但是，ART仅部分降低了这些炎症和凝结生物标志物，并且仅部分改善了通过臂动脉流介导的词典（FMD）测量的内皮功能。尽管迄今已完全忽略了ART，但仍有一个潜在的解释是持续增加HIV-CVD的风险是抑郁症。由于在20-40％的接受ART的HIV感染患者中发现了抑郁症，因此有理由认为这种常见的合并症可能导致HIV中CVD的持续升高。该应用的核心目的是确定抑郁症及其治疗与全身感染/凝血和HIV感染者的内皮功能之间的关系。我们将以以下特定目的解决这一目标：具体目的1：确定抑郁症和暴露于全身感染和HIV中凝血改变的关联。我们将对大型（n = 1525）老年人衰老研究（VACS）生物标志物队列进行观察分析，该研究还包括患者健康调查表（PH​​Q）-9分数，广泛的药物处方数据以及抑郁症和心理疗法的诊断代码；具体目的＃2：确定认知行为治疗对HIV感染的抑郁症的成年人的全身感染，改变凝血和内皮功能障碍的影响。我们将通过在印第安纳大学（Indiana University）的110名经过抑制的HIV-1 RNA水平和PHQ-9定义的重大抑郁症的蓝调认知行为治疗计划中进行殴打，并在110例ART治疗的患者中使用Blues认知行为治疗计划进行殴打，以解决这一目标。我们的多学科研究团队拥有成功解决这些目标的必要专业知识和资源。这些研究的结果将通过利用现有的HIV-CVD队列并进行新颖的，介入的试验试验来确定HIV感染患者的抑郁，抑郁治疗，炎症/凝结和内皮功能之间的关系。因此，该申请符合RFA HL-14-023的既定目标，并将为将来的介入试验提供理由，以通过治疗抑郁症来减少HIV-CVD事件。这项研究可能会为艾滋病毒临床医生提供新颖且易于实施的工具，以防止患者的CVD发病率和死亡率，并将推进HIV-CVD研究领域。