Mechanisms of Disparities in Adverse Neurocognitive Outcomes among Hispanics Aging with HIV

项目总结 艾滋病毒及其相关合并症对中枢神经系统的不良后果依然普遍。 尽管进行了高效的抗逆转录病毒治疗，但约40%的艾滋病毒携带者表现出 神经认知障碍(NCI)。与美国其他族裔/种族群体相比，艾滋病毒感染者 (HIV+)拉美裔/拉丁裔/AS，以下简称拉美裔，NCI和 神经认知功能下降；这种风险在老年时尤其明显。然而，这些背后的因素 人们并没有很好地理解差异。由国家少数民族健康和健康差距研究所指导 研究框架，本提案旨在确定潜在的不利因素的关键机制 感染艾滋病毒的西班牙裔老年患者的神经认知结果。在这组NCI的潜在预测因素中， 拟议的研究将集中在两个生物学过程--代谢综合征和肠道微生物群失调 --这在拉美裔美国人中可能特别成问题，并可能导致大脑更容易感染艾滋病毒。 这项研究还将综合物质/建筑和社会文化环境的各个方面(通过 地理编码)与代谢综合征和NCI相关，并调查它们对 艾滋病病毒的神经认知差异。我们还将探索行为(体力活动和饮食)和 医疗保健(医疗保健使用和获取、健康素养)变量。我们将在200个HIV+中收集这些数据 未感染艾滋病毒的西班牙裔(大约一半讲西班牙语)年龄在40岁及以上，并调查他们的 在三年的过程中对神经认知状态的横向和纵向影响。我们会 利用加州大学圣迭戈分校艾滋病毒神经行为研究计划的现有纵向数据来选择 100名HIV+非西班牙裔白人为对照组。以确保拟议的多学科项目取得成功 我们已经组建了一个研究团队，代表着相关学科的整合，包括 跨文化神经心理学、健康差异、医学、公共卫生、微生物学、地理学和 生物信息学和信息系统。认识到以社区为基础的参与性的重要性 在研究健康差距的研究方法方面，我们与社区诊所和 利益相关者的意见有助于加强我们的方法，并确保其与社区的相关性。我们 将建立在由PI牵头的西班牙裔现有横断面研究的基础上，招募参与者进入 拟议的研究，我们的社区伙伴关系将有助于确保我们接触到最脆弱的部分 西班牙裔社区的成员。通过这种多学科和社区综合的研究方法，我们的目标是 为了增加我们对神经认知差异机制的复杂性的理解 不同年龄的西班牙裔艾滋病毒携带者的结局。这些知识对于发展是至关重要的 有针对性的、与文化相关的干预措施，以预防或改善拉美裔和 缩小健康差距。

PROJECT SUMMARY The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent despite highly effective antiretroviral therapy, with approximately 40% of persons living with HIV showing neurocognitive impairment (NCI). Compared to other ethnic/racial groups in the United States, HIV infected (HIV+) Hispanics/Latinos/as, hereafter referred to as Hispanics, present with increased risk for NCI and neurocognitive decline; and this risk is particularly pronounced in older age. Yet, the factors underlying these disparities are not well understood. Guided by the National Institute of Minority Health and Health Disparities Research Framework, the present proposal aims to identify key mechanisms underlying adverse neurocognitive outcomes among Hispanics aging with HIV. Among the potential predictors of NCI in this group, the proposed study will focus on two biological processes -- metabolic syndrome and gut microbiome dysbiosis -- that may be particularly problematic among Hispanics and may result in greater brain vulnerability to HIV. The study will also integrate aspects of the physical/built and sociocultural environment (assessed via geocoding) that have been linked to metabolic syndrome and NCI, and investigate their influence on neurocognitive disparities in HIV. We will also explore the impact of behavioral (physical activity and diet) and healthcare (healthcare use and access, health literacy) variables. We will collect these data in 200 HIV+ and HIV-uninfected Hispanics (approximately half Spanish-speaking) aged 40 and over, and investigate their impact on neurocognitive status cross-sectionally and longitudinally over the course of three years. We will leverage existing longitudinal data from the UCSD HIV Neurobehavioral Research Program to select a comparison group of 100 HIV+ non-Hispanic Whites. To ensure the success of the proposed multidisciplinary approach, we have assembled a research team representing an integration of relevant disciplines, including cross-cultural neuropsychology, health disparities, medicine, public health, microbiomics, geography, and bioinformatics, and information systems. Recognizing the importance of a community-based participatory research approach in the study of health disparities, we have partnered with community clinics and stakeholders whose input has helped strengthen our approach and assure its relevance to the community. We will build on existing cross-sectional studies in Hispanics led by the PI for recruitment of participants into the proposed study, and our community partnerships will help assure that we reach the most vulnerable segments of the Hispanic community. With this multidisciplinary and community integrated approach to research, we aim to increase our understanding of the complexity that underlies mechanisms of disparities in neurocognitive outcomes among diverse groups of Hispanics aging with HIV. Such knowledge is crucial for the development of targeted, culturally relevant interventions to prevent or ameliorate HIV-associated NCI among Hispanics and reduce health disparities.