Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH

摘要LSUHSC CARC研究组件1： PLWH中的社区和人际压力、酒精和慢性共病 老年艾滋病毒感染者（PLWH）是一个脆弱的人群，患慢性病和老年病的风险更高。 综合征（即，代谢改变、糖尿病、心血管疾病、癌症、肾脏疾病和 骨质疏松症）。艾滋病毒/艾滋病感染者的心理社会和生理压力水平较高， 与免疫状态较差、病毒载量随时间增加、疾病进展更快和更高的 死亡率。高危酒精使用可进一步加重PLWH的共病状况; 患酒精使用障碍（AUD）的风险高出两到三倍。迫切需要更深入的 了解社区和人际层面的社会决定因素在慢性病中发挥的作用， PLWH中的合并症。社区和社会空间是社会活动的重要背景， 决定因素影响健康和健康行为。然而，目前的科学研究中存在着一个根本性的差距。 关于人们在这些情况下实际经历的循证知识，他们对护理的影响， PLWH，以及它们如何与次优护理的其他驱动因素相互作用，如有风险的酒精使用和临床 合并症。我们的初步数据表明，压力暴露在多个层面上对酒精使用的重要作用 结果和合并症。研究组成部分1（RC 1）的目的是确定 社区和人际压力对PLWH中行为和慢性共病的影响， 酒精的使用会影响神经通路我们的中心假设是，在社区中暴露于压力源 和人际水平将影响临床合并症，如心脏代谢和认知结果， PLWH，通过对酒精使用的影响和额外的行为和应对机制。我们的方法将 涉及将个人水平的人口统计学和临床数据沿着邻居数据结合起来， 艾滋病毒感染者和艾滋病毒携带者-成人的人际接触。我们将采用先进的建模技术， 确定个人、人际和社区层面可测量变量与潜在变量之间的关系， 结构，纵向测试酒精消费的影响的调解。我们还将探讨在 从该队列收集的深度个体空间和时间地理瞬时评估（GMA）数据。 RC 1提出的研究将基础科学与行为科学和社会科学联系起来，以流行病学来确定 酒精在HIV相关合并症中的作用。我们的项目将提供关键数据， 多层次的干预措施，以改善少数民族社区和社区的健康， 艾滋病毒和相关合并症的最大负担。

Abstract LSUHSC CARC Research Component 1: Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH Aging persons living with HIV (PLWH) are a vulnerable population at higher risk for chronic illnesses and geriatric syndromes (i.e., metabolic alterations, diabetes, cardiovascular disease, cancer, renal disease, and osteoporosis). Higher levels of both psychosocial and physiological stress among PLWH have also been associated with poorer immune status, increased viral load over time, faster disease progression, and higher rates of mortality. Comorbid conditions in PLWH can be further exacerbated by at-risk alcohol use; and PLWH are two to three times more at risk of alcohol use disorder (AUD). There is a critical need for a deeper understanding of the roles that social determinants at the community and interpersonal levels play in chronic comorbidities in PLWH. Neighborhoods and social spaces are important contexts through which social determinants act to shape health and health behavior. However, there is a fundamental gap in current scientific evidence-based knowledge about what people actually experience in these contexts, their impact on care for PLWH, and how they may interact with other drivers of sub-optimal care such as at-risk alcohol use and clinical comorbidities. Our preliminary data suggest a significant role of stress exposure at multiple levels on alcohol use outcomes and comorbidities. The objective of Research Component 1 (RC1) is to determine the impact of community and interpersonal stress on behavioral and chronic comorbidities among PLWH, and the unique role that alcohol use plays in the pathways. Our central hypothesis is that exposure to stressors at the community and interpersonal levels will impact clinical comorbidities, such as cardiometabolic and cognitive outcomes in PLWH, through impacts on alcohol use and additional behavioral and coping mechanisms. Our approach will involve the incorporation of individual level demographic and clinical data along with neighborhood data and interpersonal exposures from PLWH and HIV- adults. We will incorporate advance modeling techniques to determine the relation of individual, interpersonal, and community level measurable variables and latent constructs, testing longitudinally the mediation of the effects by alcohol consumption. We will also explore in depth individual space and time geographical momentary assessment (GMA) data collected from this cohort. RC1’s proposed research links basic science with behavioral and social sciences, to epidemiology to determine the role in alcohol in HIV-associated comorbidities. Our project will provide key data that will directly inform multilevel interventions to improve the health of minority communities and neighborhoods that continually sustain the biggest burden of HIV and associated comorbidities.