HIV and musculoskeletal frailty: implications for care, policy and research

艾滋病毒和肌肉骨骼脆弱：对护理、政策和研究的影响

• 批准号: 10552738
• 负责人: Elena Losina
• 金额: $ 90.16万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-18 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10552738
• 关键词: Address; Age; Age-Years; Aging; Attenuated; Body Weight decreased; Budgets; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Clinical; Clinical Management; Computer Simulation; Consequences of HIV; Cost Effectiveness Analysis; Data; Diagnosis; Economics; Effectiveness of Interventions; Epidemic; Evaluation; Exercise; Exposure to; Fall prevention; Fatigue; Fracture; General Population; Goals; Guidelines; HIV; Hand Strength; Health Benefit; Hepatitis C co-infection; Incidence; Individual; Infection; Inflammation; Intervention; Knowledge; Lead; Life Expectancy; Medical Care Costs; Metabolic syndrome; Methodology; Methods; Modeling; Muscle function; Musculoskeletal; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Natural History; Opportunistic Infections; Osteoporosis; Outcome; Output; Persons; Pharmaceutical Preparations; Physical activity; Physicians; Policies; Policy Maker; Policy Research; Polypharmacy; Population; Prevalence; Prevention program; Prevention strategy; Process; Quality-Adjusted Life Years; RNA; Recurrence; Research; Resources; Series; Structure; Substance Use Disorder; Time; Tobacco; Tobacco use; Translating; Translational Research; United States; antiretroviral therapy; cardiovascular fitness; care outcomes; comorbidity; cost; cost effective; cost effectiveness; cost estimate; disability; effective intervention; exercise intervention; exercise program; experience; fall risk; falls; frailty; immune function; improved; innovation; insight; interest; intervention cost; large datasets; models and simulation; multi-component intervention; multidisciplinary; prevent; programs; reduced muscle mass; response; routine screening; sarcopenia; screening; societal costs; treatment guidelines; treatment strategy; walking speed; years of life lost

The broad objective guiding our research is to provide critical insights to clinicians and decision makers regarding the value of interventions to diagnose, prevent and reduce progression of physical frailty (PF) in people with HIV (PWH). More than a million persons in the United States live with HIV, a previously fatal infection that has become a highly treatable chronic condition with the use of antiretroviral therapy. The life expectancy of PWH now approaches that of the general population, revealing an earlier than expected and growing prevalence of PF. PF carries substantial individual and societal burden. If unmanaged, it may lead to loss of independence, recurrent falls, fractures, disability, and death. Routine screening and management of PF has not been part of the treatment guidelines, which instead focused on opportunistic infections early in the HIV epidemic, and more recently on HCV co-infection, CVD, and tobacco and other substance use disorder. The challenges in diagnosing and managing PF and its associated conditions in PWH are further exacerbated by the gap between ‘what we know’ and ‘what we do.’ Evidence indicates that pre-frailty and early stages of PF are reversible with timely diagnosis and effective interventions. However, this evidence has not been translated to routine HIV care. Regular frailty assessment is essential to prevent falls, fractures and other consequences, yet most PWH have not been assessed for PF. Evidence also suggests that multimodal interventions including cardiovascular and strength exercise in conjunction with fall prevention, treatment of osteoporosis, and careful medication de-escalation are effective in reducing musculoskeletal manifestations of PF. There are similar benefits for PWH, however this evidence has not been translated into routine HIV care. Guidance on choosing among effective interventions to maximize health benefits for PWH with constrained budgets is lacking. Knowledge of the cost-effectiveness (value) and budgetary impact of these programs would help facilitate translation of research findings into clinical management of PWH. Cost-effectiveness analysis is an important methodology that helps to inform choice among multiple efficacious programs when resources including data, time, and money are limited. We propose to develop a computer simulation model that portrays the natural history and treatment of PF in PWH to narrow the gap between evidence and practice by assessing the value of three major strategies to prevent and attenuate progression of PF in PWH: 1) timely diagnosis of PF; 2) implementation of structured strengthening and cardiovascular fitness improvement exercise programs to reduce falls and fractures and prevent PF incidence and slow its progression; and 3) use of fall prevention programs, including polypharmacy de-escalation, osteoporosis screening and diagnosis and management to reduce falls and fractures.

指导我们研究的总体目标是为临床医生和决策者提供重要的见解 关于诊断、预防和减少身体虚弱 (PF) 进展的干预措施的价值 艾滋病毒感染者（PWH）。 美国有超过一百万人感染艾滋病毒，这种以前致命的感染现已成为一种致命的感染 使用抗逆转录病毒疗法可以高度治疗的慢性疾病。现在艾滋病患者的预期寿命 接近一般人群，揭示了 PF 的患病率比预期更早且不断增长。 PF 带来沉重的个人和社会负担。如果不加以管理，可能会导致丧失独立性、反复发作 跌倒、骨折、残疾和死亡。 PF 的常规筛查和管理尚未纳入 治疗指南，重点关注艾滋病毒流行早期的机会性感染，等等 最近关于HCV合并感染、CVD以及烟草和其他物质使用障碍。 诊断和管理 PF 及其相关疾病的 PWH 挑战进一步加剧 通过“我们所知道的”和“我们所做的”之间的差距。有证据表明，虚弱前期和 PF 的早期阶段 通过及时诊断和有效干预，是可逆的。但该证据尚未翻译 常规艾滋病毒护理。定期进行虚弱评估对于防止跌倒、骨折和其他后果至关重要， 但大多数感染者尚未接受 PF 评估。有证据还表明，多模式干预措施包括 心血管和力量锻炼与预防跌倒、治疗骨质疏松症以及小心谨慎相结合 药物降级可有效减少 PF 的肌肉骨骼表现。还有类似的 对感染者和艾滋病患者有好处，但这一证据尚未转化为常规艾滋病毒护理。选择指导 缺乏有效的干预措施，以在预算有限的情况下最大限度地提高感染者健康福利。 了解这些计划的成本效益（价值）和预算影响将有助于促进 将研究成果转化为 PWH 的临床管理。 成本效益分析是一种重要的方法，有助于在多种有效的方案中进行选择。 当资源（包括数据、时间和金钱）有限时。我们建议开发一台计算机 模拟模型描绘了 PWH 中 PF 的自然史和治疗，以缩小两者之间的差距 通过评估预防和减缓疾病进展的三种主要策略的价值来提供证据和实践 PWH中的PF：1）及时诊断PF； 2）实施结构化强化和心血管 健身改善锻炼计划，以减少跌倒和骨折，预防肺纤维化的发生并减缓其发生 进展； 3) 使用跌倒预防计划，包括复方药物降阶梯、骨质疏松症 筛查、诊断和管理，以减少跌倒和骨折。