Chicago WIHS Consortium V (CWC)

描述（由申请人提供）：由于艾滋病毒预防治疗网络052研究证明，早期开始抗逆转录病毒（ART）可降低艾滋病毒性传播和临床事件的发生率，并且妇女占全球艾滋病毒感染者的50%，因此需要更好地了解感染艾滋病毒的妇女如何开始，坚持和响应ART以及这种疗法如何影响艾滋病毒/艾滋病的预防，治疗和护理/治愈。非洲裔美国妇女继续承担着妇女中最大的艾滋病毒疾病负担，其新发艾滋病毒感染率、艾滋病诊断率和死亡率都高得不成比例。该提案的主要目标是继续保持芝加哥WIHS联盟（CWC）作为临床研究基地和科学领袖联盟的高水平生产力，并在促进我们对美国妇女中不断发展的艾滋病毒流行的理解方面取得了良好的记录。我们将继续迅速招募和保留一个具有代表性的感染艾滋病毒和有感染风险的妇女队列，以收集最高质量的数据，以便领导和开展创新的流行病学分析和多学科调查，以确定已治疗的妇女艾滋病毒疾病的特征。在WIHS-V 5年期间，我们将继续设计、实施、综合和传播调查结果，探索艾滋病毒、抗逆转录病毒治疗、病毒抑制、社会人口统计学、行为、精神疾病、免疫生物标志物、绝经期和合并症之间的动态和复杂关系，而不是专注于任何单一因素的影响。CWC调查小组建议扩大并保留芝加哥队列，并将分析模型应用于纵向社会/行为、临床、神经认知和发病机制数据，以开发和测试性别特异性预后指数（“WIHS指数”）。我们的目标是确定HIV疾病表型的心理、神经内分泌、遗传和免疫学预测因子，包括那些以炎症、激活和细胞衰老为特征的疾病，并确定与HIV相关的非艾滋病（HANA）合并症的临床和临床前测量的关联。由于有证据表明，潜在的可改变因素，如未经治疗的精神疾病、慢性生活压力和成瘾物质的使用，可能会导致炎症和加速端粒缩短，端粒缩短是细胞衰老的关键分子标志物，我们将探索精神病学诊断、激素模式和先天和适应性免疫系统标志物之间的相互作用。考虑到我们的队列中这些可改变因素的高发生率，我们提出了一项多地点随机对照试验，以验证基于跨理论模型的基于证据的计算机化定制干预，以解决戒烟、提高抗逆转录病毒治疗依从性、有效管理压力、抑郁和体重的风险行为。我们希望通过这些与艾滋病毒有关的工作，确定可用于各级艾滋病毒护理（社区、诊所和实验室）的新工具，使临床医生及其女性患者能够改善感染艾滋病毒的女性的预后和生活。

DESCRIPTION (provided by applicant): With the HIV Prevention Treatment Network 052 study proving that early antiretroviral (ART) initiation reduces rates of HIV sexual transmission and clinical events, and with women making up 50% of people living with HIV globally, a better understanding of how women with HIV start, stay on and respond to ART and how this therapy impacts prevention, treatment, and care/cure of HIV/AIDS is needed. African American women continue to bear the largest burden of HIV disease among women, with disproportionately higher rates of new HIV infections, AIDS diagnoses, and mortality. The major goal of this proposal is to continue the high level of productivity of the Chicago WIHS Consortium (CWC) as both a clinical research site and as a consortium of scientific leaders with a track record of advancing our understanding of the evolving HIV epidemic in US women. We will continue to rapidly recruit and retain a representative cohort of women with and at risk for HIV, to collect th highest quality data in order to lead and pursue innovative epidemiologic analyses, and multidisciplinary investigations to characterize treated HIV disease in women. Over the WIHS-V five year period, we will continue to design, implement, synthesize, and disseminate findings from investigations which explore the dynamic and complex relationships between HIV, ART, viral suppression, sociodemographics, behaviors, mental illness, immune biomarkers, menopausal stage, and comorbidities rather than focusing on the impact of any one single factor. The CWC investigative team proposes to expand and retain the Chicago cohort and to apply analytic modeling to longitudinal social/behavioral, clinical, neurocognitive, and pathogenesis data to develop and test a gender specific prognostic index ("WIHS Index"). We aim to identify psychological, neuroendocrine, genetic, and immunologic predictors of HIV disease phenotypes, including those characterized by inflammation, activation, and cellular senescence and determine the association with clinical and pre-clinical measures of HIV associated non AIDS (HANA) co-morbidities. Since evidence suggests that potentially modifiable factors, such as untreated mental illness, chronic life stress, and use of addictive substances can contribute to inflammation and accelerate telomere shortening, a key molecular marker of cellular senescence, we will explore the interactions between psychiatric diagnoses, hormonal patterns, and markers of the innate and adaptive immune system. Given the high rates of these modifiable factors in our cohort, we propose a multi-site randomized controlled trial to test an evidence based computerized tailored intervention based on the Transtheoretical Model to address risk behaviors concurrently aimed at smoking cessation, improving ART adherence, and effectively managing stress, depression, and weight. Through these WIHS V efforts, we hope to identify new tools that can be used at all levels of HIV care (community, clinic, and laboratory) to empower clinicians and their female patients to improve the prognosis and lives of women with HIV.