Pathways to successful aging among perinatally HIV-infected and exposed young adults: Risk, resilience, and the role of perinatal HIV infection

艾滋病毒治疗和预防方面的进展已导致数百万围产期艾滋病毒感染者（PHIV）和围产期 暴露于艾滋病毒但未受感染的儿童（PHEU）存活到青春期和青年期。成年早期 可能是一个不稳定的发展时期，PHIV年轻人（YA）的精神疾病风险特别高。 健康问题，危险行为，以及由于妥协的“完美风暴”而难以实现成人里程碑 健康、生活压力和神经认知缺陷。这些风险因艾滋病毒控制不当而加剧， PHIV和PHEU YA都遇到了心理社会压力，导致慢性炎症反应， 损害精神功能、神经认知和整体健康结果。在过去的15年里，CASAH 随访了340名生活在纽约弱势社区的PHIV和PHEU青年（年龄在9-16岁之间） 城市，记录整个童年，青春期和成年期的风险和弹性。这种竞争 继续CASAH（R 01-MH 69133 -15），CASAH 4，将随访该队列至青年期（20岁-早期 30年代），导致最全面的纵向数据集之一的心理健康，健康风险行为， 和PHEU YA之间的成人里程碑的实现。在社会行动理论（SAT）的指导下， CASAH 4提供了一个独特的机会，利用我们独特的纵向数据集来了解两者的影响 终身艾滋病毒感染以及心理健康的环境、社会调节和自我调节决定因素， 健康风险行为和成人里程碑成就。在CASAH 4中，我们的目标是1）检查艾滋病毒的影响 感染对行为健康结果的影响（例如，心理健康、性风险、物质使用、依从性）和 成人里程碑的实现（例如，教育，职业，独立性）; 2）检查SAT如何告知风险 和保护因素影响YA行为健康和成年里程碑的实现; 3）探索轨迹 青少年和青年期的行为健康以及这些轨迹的SAT信息预测器; 和4）比较三个全球青年的行为健康结果及其SAT信息预测因素 按青春期早期（9-12岁）、中期（13-15岁）和晚期（16-19岁）的HIV状态分组。建筑 在我们以前的工作中，我们将加强对成人里程碑、精神功能和 神经认知功能，并将增加生物医学健康指标（炎症和免疫激活 与精神疾病和神经认知功能相关的生物标志物）与HIV RNA病毒载量的关系， 已采集CD 4+细胞计数。CASAH为风险和弹性研究做出了重大贡献 在PHIV和PHEU青年中发表了117篇出版物和65篇科学报告，并直接告知了心理健康， 健康和艾滋病毒预防干预和服务系统在美国和国外。一个多学科和 作为一个跨文化的团队，我们有一个独特的机会将我们的工作扩展到年轻的成年人， 行为风险轨迹和年轻成年人功能的可修改预测因子，并告知 及时，有针对性的，以证据为基础的干预措施，在全球范围内脆弱的艾滋病毒和PHEU。

Advances in HIV treatment and prevention have led to millions of perinatally HIV-infected (PHIV) and perinatally HIV-exposed, but uninfected (PHEU) children surviving into adolescence and young adulthood. Young adulthood can be a precarious developmental period, and PHIV young adults (YA) are at particularly high risk for mental health problems, risk behaviors, and difficulties achieving adult milestones due to a “perfect storm” of compromised health, life stressors, and neurocognitive deficits. These risks are exacerbated by inadequately controlled HIV, and psychosocial stressors encountered by both PHIV and PHEU YA, leading to chronic inflammatory responses that compromise psychiatric function, neurocognition, and overall health outcomes. For the past 15 years, CASAH has followed 340 PHIV and PHEU youth (enrolled at ages 9-16 years) living in vulnerable communities in New York City, documenting risk and resilience across childhood, adolescence, and emerging adulthood. This competing continuation of CASAH (R01-MH69133-15), CASAH4, will follow this cohort through young adulthood (20s-early 30s), leading to one of the most comprehensive longitudinal data sets on mental health, health risk behavior, and achievement of adult milestones among PHIV and PHEU YA. Guided by Social Action Theory (SAT), CASAH4 offers a unique opportunity leverage our unique longitudinal data set to understand the impact of both lifelong HIV infection and also contextual, social-regulation, and self-regulation determinants of mental health, health risk behaviors, and adult milestone achievement. In CASAH4 we aim to 1) examine the impact of HIV infection on behavioral health outcomes (e.g., mental health, sexual risk, substance use, adherence) and achievement of adult milestones (e.g., education, vocation, independence); 2) examine how SAT-informed risk and protective factors affect YA behavioral health and achievement of adult milestones; 3) explore trajectories of behavioral health across adolescence and young adulthood and SAT-informed predictors of these trajectories; and 4) compare behavioral health outcomes and their SAT-informed predictors among youth across three global cohorts by PHIV-status at early (9-12 years), middle (13-15 years), and late (16-19 years) adolescence. Building on our previous work, we will enhance our assessment of adult milestones, psychiatric function, and neurocognitive function, and will add biomedical health indicators (inflammation and immune activation biomarkers associated with psychiatric disorders and neurocognitive function) to the HIV RNA viral load and CD4+ cell count already collected. CASAH has made significant contributions to research on risk and resilience in PHIV and PHEU youth with 117 publications and 65 scientific presentations, and has directly informed mental- health and HIV-prevention interventions and service systems in the US and abroad. With a multidisciplinary and cross-cultural team, we have a unique opportunity to extended our work into young adulthood, to identify modifiable predictors of behavioral risk trajectories and young adult function, and to inform the development of timely, targeted, and evidence-based interventions for vulnerable PHIV and PHEU across global contexts.