Multi-Dimensional Successful Aging Among HIV-Infected Adults

艾滋病毒感染者的多维成功老龄化

• 批准号: 8604174
• 负责人: DILIP V. JESTE
• 金额: $ 68.78万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-01-09 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8604174
• 关键词: Acquired Immunodeficiency Syndrome; Adult; Affect; Age; Aging; American; Biological Aging; Biological Markers; Blood; C-reactive protein; CCL2 gene; CD4 Positive T Lymphocytes; Cell Count; Chronic; Clinical; Cognitive; Cohort Effect; Demographic Factors; Development; Disease; Equilibrium; F2-Isoprostanes; Future; Goals; HIV; Impaired cognition; Individual; Individual Differences; Institutes; Insulin Resistance; Interleukin-6; Intervention; Investigation; Laboratories; Lead; Length; Life; Life Expectancy; Mails; Mediator of activation protein; Medical; Methodology; Modeling; National Institute of Mental Health; Older Population; Outcome; Outcome Measure; Participant; Personal Satisfaction; Persons; Physical Function; Plasma; Preventive Intervention; Psychological Factors; Psychosocial Factor; Public Health; Quality of life; Recruitment Activity; Research; Research Design; Risk Factors; Role; Severities; Severity of illness; Spirituality; Structure; Surveys; System; Telephone; Telephone Interviews; Therapeutic Intervention; Tumor Necrosis Factor-alpha; Variant; Viral Load result; Visit; age difference; age effect; aged; allostatic load; antiretroviral therapy; base; cognitive function; cohort; design; dimer; disability; follow-up; human TNF protein; improved; inflammatory marker; interest; lifestyle factors; longitudinal design; neurobehavioral; novel; optimism; programs; psychosocial; public health relevance; resilience; social; social stress; telomere; working group

DESCRIPTION (provided by applicant): The life expectancy of adults receiving antiretroviral therapy (ART) has been increasing progressively. By 2015 one-half of HIV+ people in the U.S. will be over age 50, and this number is expected to continue to rise. While there has been a growing interest in aging with HIV, there is a dearth of research on successful aging with HIV. We define successful aging as a multi-dimensional construct with physical, cognitive, and psychosocial domains, with the downstream outcome being self-perceived successful aging. The proposed study will be the first large-scale investigation examining the relationship of positive psychological factors such as resilience, hardiness, optimism, and social engagement along with laboratory-based systemic markers of biological aging and HIV disease severity to the different domains of successful aging in HIV+ individuals as compared to well- matched Non-HIV-infected Comparison subjects (NCs). Subjects will include 120 HIV+ adults and 90 NCs aged 36-65 years. The biomarkers will include: telomere length, F2-isoprostanes, inflammatory markers (high- sensitivity C-reactive protein, IL-6, d-dimer, TNF-alpha, CCL2, d-dimer and sCD14), insulin resistance, and allostatic load, and, among HIV+ individuals, indicators of HIV disease severity (plasma HIV viral load, CD4+ T-cell count, AIDS/nonAIDS). Participants in each decade (36-45, 46-55, 56-65) will be evaluated using a structured Multi-cohort Longitudinal Design (sMLD), with balanced recruitment providing 40 HIV+ and 30 HIV- subjects per decade. The sMLD enables separation of cohort effects from developmental (within-subject) aging effects, allowing us to estimate aging trajectories across the entire age range of 36-65 years. Subjects will be followed for up to 4 years, with in-person bi-annual visits for detailed assessments, and evaluated with follow- up telephone interviews and mail surveys in the years in which they are not seen in person. We will examine the longitudinal trajectories of clinical outcome measures and positive psychological factors as well as biomarkers of aging and HIV disease, and compare them to those in NC subjects. Our first aim is to determine whether and how trajectories of successful aging differ between HIV+ and NC groups. We will also identify predictors of successful aging trajectories in HIV+ and NC groups. This project is related to NIMH Strategic Objective #2: charting illness trajectories to determine when, where, and how to intervene with HIV+ individuals. This study is novel in its focus on multi-dimensional characterization and recognition of predictors of successful aging in HIV+ adults as well as the use of advanced statistical methodology that allows for the distinction of cohort and developmental aging effects. We anticipate that successful aging trajectories will differ between HIV+ and NC groups suggesting that successful aging paradigms established in non-HIV-infected cannot be simply be generalized to HIV-infected persons. Understanding potentially malleable protective versus risk factors at an individual level may lead to development of new interventions aimed at increasing the likelihood of successful aging among people living with HIV.

描述（由申请人提供）：接受抗逆转录病毒治疗（ART）的成年人的预期寿命正在逐步增加。到2015年，美国一半的艾滋病毒感染者将超过50岁，预计这一数字将继续上升。尽管人们对艾滋病毒携带者的衰老越来越感兴趣，但关于艾滋病毒携带者成功衰老的研究却很少。我们将成功衰老定义为身体、认知和社会心理领域的多维结构，其下游结果是自我感知的成功衰老。这项拟议的研究将是第一次大规模的调查，研究积极的心理因素，如弹性、耐受性、乐观主义和社会参与，以及基于实验室的生物衰老和HIV疾病严重程度的系统标记，与HIV+个体成功衰老的不同领域的关系，与匹配良好的非HIV感染对照受试者（nc）相比。研究对象包括120名HIV阳性成人和90名年龄在36-65岁之间的nc。生物标志物将包括：端粒长度、f2 -异前列腺素、炎症标志物（高敏c反应蛋白、IL-6、d-二聚体、tnf - α、CCL2、d-二聚体和sCD14）、胰岛素抵抗和适应负荷，以及在HIV+个体中，HIV疾病严重程度指标（血浆HIV病毒载量、CD4+ t细胞计数、艾滋病/非艾滋病）。每个十年的参与者（36-45、46-55、56-65）将使用结构化的多队列纵向设计（sMLD）进行评估，每十年均衡招募40名HIV+和30名HIV-受试者。sMLD能够将队列效应与发育（受试者内）衰老效应分离开来，使我们能够估计36-65岁整个年龄范围内的衰老轨迹。受试者将被跟踪长达4年，每年两次亲自访问以进行详细评估，并在未亲自见到的年份通过电话访谈和邮件调查进行评估。我们将研究的纵向轨迹