Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies

摘要 美国约有110万艾滋病毒携带者(PLWH)，估计新感染人数为39782人 2016年被诊断出感染了艾滋病毒。多中心艾滋病队列研究(MACS)和妇女机构间艾滋病毒 WIHS研究是美国历史最悠久的两项艾滋病毒队列研究。成立于1984年， 1993年以来，这些在美国的队列目前跟踪了2,235名男性和2,304名女性艾滋病毒携带者， 以及高风险但未感染的控制组。艾滋病毒在首都的流行比例很高，总体来说 哥伦比亚特区成人和青少年居民中艾滋病毒感染率为1.9%。大致 40岁至49岁的区议会居民中有3.7%的人感染艾滋病毒，50岁至59岁的居民中有5.2%的人感染艾滋病毒。这个 在美国，感染艾滋病毒的终生风险最高的是华盛顿特区，估计每17人中就有1人感染艾滋病毒 预计在他们的一生中感染艾滋病毒，紧随其后的是邻近的马里兰州居民中每56人中就有1人有感染艾滋病毒的风险。 继续跟踪我们招募的妇女，并扩大我们的队列，以包括一个有代表性的团体 在这一艾滋病毒流行程度很高的区域，男女平等至关重要。我们的研究将集中在 了解有助于长期治疗成功的行为和社会决定因素 失败，重点是确定可能转化为创新干预措施的关键复原力因素 实现艾滋病毒护理连续体的全球目标，以改善治疗吸收和病毒抑制，以 降低发病率和死亡率。我们有四个目标来实现我们的目标。(一)继续保持我们的强大 与国家MACS/WIHS CCS在协议开发、实施、 参与者注册、保留、数据获取和子研究参与；(2)领导CCS范围的工作 为了了解影响治疗依从性的心理社会和行为决定因素，病毒学 (3)确定治疗和治疗的有效性； 预防指南和确定在提供服务方面的差异，以应对高相关的常见疾病 死亡率；以及(4)探索艾滋病毒、老龄化和相关的共病，包括 当代背景下的微血管/血管功能、微生物群、神经认知衰退 抗逆转录病毒治疗方案，以及男女之间的听力和平衡障碍。我们的长期合作 目标是改善艾滋病毒携带者的健康，并帮助预防艾滋病毒携带者 血清转换。

ABSTRACT About 1.1 million people are living with HIV (PLWH) in the US, with an estimated 39,782 individuals newly diagnosed with HIV in 2016. The Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS) are two of the longest standing HIV cohort studies in the United States. Established in 1984 and 1993, respectively, these US-based cohorts currently follow 2,235 men and 2,304 women living with HIV, alongside high-risk but uninfected controls. HIV is at epidemic proportions in the nation’s capital, with overall HIV prevalence of 1.9% among the District of Columbia (DC) adult and adolescent residents. Approximately 3.7% of DC residents aged 40 to 49 years and 5.2% of residents aged 50 to 59 years are living with HIV. The highest life time risk of acquiring HIV in the U.S. is highest in DC with an estimated 1 in 17 individuals anticipated to acquire HIV in their lifetime, followed by 1 in 56 risk among the neighboring Maryland residents. Continuing to follow the women we have recruited and expanding our cohort to include a representative group of men and women is imperative in this region with epidemic levels of HIV. Our research will be focused on understanding the behavioral and social determinants that contribute to long term treatment success and failure, with a focus on identifying key resilience factors that may translate into innovative interventions to achieve the global goals of the HIV care continuum, to improve treatment uptake and viral suppression to decrease morbidity and mortality. We have four aims to achieve our goals. (1) To continue our strong collaborative relationship with the national MACS/WIHS CCS in protocol development, implementation, participant enrollment, retention, data acquisition, and sub-study participation; (2) To lead the CCS-wide effort to understand the psychosocial and behavioral determinants that contributes to treatment adherence, virologic suppression, and healthy coping among PLWH in the US; (3) To determine the effectiveness of treatment and prevention guidelines and identify disparities in service delivery for common morbidities with high associated mortality; and (4) To explore HIV, aging, and associated co-morbidities, including the role of microvascular/vascular function, the microbiome, neurocognitive decline in the context of contemporary antiretroviral treatment regimens, and hearing and balance disorders among men and women. Our long-term goal is to improve the health of people living with HIV and to help prevent those without HIV from seroconverting.