Do brain differences influence HIV risk behavior? A study of young urban women

描述（由申请人提供）：年轻的城市少数民族妇女占越来越多的新艾滋病毒/性传播感染（STIs），而预防工作严重滞后。我们的首要假设是，在某些人身上，标准的艾滋病干预措施的效果可能会被大脑在做出最佳“在紧要关头”风险决策的能力上的差异所削弱。在正常发育过程中，青少年对奖励敏感、冲动驱动的大脑逐渐变成对奖励冲动抑制能力增强的成人大脑。然而，这种大脑成熟有很大的个体差异——发育迟缓（暂时的或持续的）可能导致按时间顺序排序的成年人具有“青少年”大脑的决策特征。基于我们的试点数据集（n=142），我们假设发育迟缓可能会导致次优性决策（反映在一系列风险行为中，包括过早发生第一次性行为、频繁无保护的性行为、多个性伴侣、多重性传播感染），从而使一组年轻女性处于艾滋病毒的高性风险（HSR）中。具有这种HSR表型的年轻女性是否确实具有“年轻”大脑行为脆弱性的模式（bbv是与奖励相关的大脑过程，可以破坏最佳决策）？组间设计（HSR vs.低性风险，LSR）将从一个城市的计划生育中招募18-24岁的女性，该城市的艾滋病毒感染率是全国的5倍，黑人占新艾滋病毒病例的66%。该研究将使用选定的fMRI探针和行为任务，比较HSR和LSR组的bbv在4个与HIV风险相关的领域（更高的奖励敏感性，更大的风险承担和更差的奖励冲动抑制，以及更大的拒绝敏感性）。我们开创性的“概念验证”R21研究的具体目的是确定患有高铁的年轻城市女性是否比患有低铁的女性有更大的bbv。为了实现这一目标，我们将：A)比较高铁和低铁的大脑先验区域的激活；B)将在扫描任务中获得的大脑激活模式与相关（非扫描）行为评分相关联。我们假设，那些患有HSR的人在一个或多个与HIV风险相关的领域中表现出明显更大的脆弱性（在先验区域中表现出更大的反应），并且行为得分将与指定的先前感兴趣区域的大脑活动显著相关，直接将大脑活动与风险相关行为联系起来。我们的探索目的是通过调查评估来描述高收入人群和低收入人群的人口特征、健康和艾滋病毒风险行为，为研究其他潜在关联（童年创伤、伴侣暴力、抑郁、认知能力）提供假设生成数据库

DESCRIPTION (provided by applicant): Young, urban minority women account for a growing number of new HIV/sexually transmitted infections (STIs), while prevention efforts are seriously lagging behind. Our overarching hypothesis is that efficacy of standard HIV interventions may be undermined in certain individuals by brain differences in the ability to make optimal "in the heat of the moment" risk decisions. In normal development, the reward-sensitive, impulse-driven brain of adolescence gradually becomes an adult brain with improved inhibition of reward impulses. This brain maturation, however, has a great deal of individual variability - and developmental delay (temporary or sustained) can result in a chronological adult with decision-making characteristics of an 'adolescent' brain. Based on our pilot dataset (n=142), we hypothesize that developmental delay may contribute to sub-optimal sexual decision-making (reflected in a cluster of risk behaviors - including early age of 1st sex, frequent unprotected sex, multiple sexual partners, multiple STIs) putting a subgroup of young women, at high sexual risk (HSR) for HIV. Do young women with this HSR phenotype indeed have a pattern of "younger" brain- behavioral vulnerabilities (BBVs are reward-relevant brain processes that can undermine optimal decision- making)? A between-groups design (HSR vs. low sexual risk, LSR) will recruit 18-24 year-old females from an urban family planning in a city with 5 times the national HIV rate with blacks accounting for 66% of new HIV cases. The study will compare BBVs for the HSR v LSR group in 4 domains with HIV risk-relevance (heightened reward sensitivity, greater risk taking and poor inhibition of reward impulses, and greater rejection sensitivity), using selected fMRI probes and behavioral tasks. The specific aim of our pioneering "proof-of- concept" R21 study is to determine whether young urban women with HSR have greater BBVs compared to those that have LSR. To accomplish this we will: A) Compare activation in a priori regions of the brain between those with HSR vs. LSR and~ B) Correlate brain activation patterns obtained in the on-scanner tasks with linked (off-scanner) behavioral scores. We hypothesize that those with HSR will evidence significantly greater vulnerability (greater response in a priori regions) in one or more domains relevant for HIV risk, and that behavioral scores will be significantly correlated with the brain activity in the specified a prior regions of interest, directly linking brain activity with the risk-relevant behavior. Our exploratoy aim is to characterize demographic, health and HIV risk behaviors of the HSR and LSR groups through survey assessment, providing an hypothesis-generating data-base for examining other potential associations (childhood trauma, partner violence, depression, cognitive ability) with our HIV risk-relevant brain data. Demonstrating a difference in BBVs for young women at HSR v. LSR for HIV and identifying the underlying brain processes would enable our long-term goals: to encourage a broader biologically-based understanding of HIV risk, and to open the way for new brain-targeted and/or brain-informed strategies for vulnerable individuals, with life-saving benefit.