Determinants and Consequences of Frailty among Aging HIV-infected Persons

描述（由申请人提供）：我的职业目标是改善老年艾滋病毒感染者和高危社区的健康状况，并支持制定针对这些社区的社会边缘化，资源有限和临床弱势成员的健康促进干预措施。虚弱是一种重要的与年龄相关的状态，易受压力因素的影响，导致过早死亡和广泛的与年龄相关的不良临床结局，包括住院率增加，残疾和机构化。因此，虚弱已被医学研究所确定为美国改善医疗保健的首要目标。早期数据表明，老年艾滋病毒感染者中虚弱的发生率增加。决定虚弱状态（虚弱进展和恢复）之间转换的流行病学和生物学因素尚未得到很好的表征。拟议的研究嵌套在与静脉注射经历相关的艾滋病（ALIVE）队列中，代表老年、少数注射吸毒者（IDUs），他们面临与虚弱相关后果的最大风险。目的1利用纵向ALIVE数据来研究HIV和多药耐药在老年HIV感染者和 流行病学上可比的未感染艾滋病毒的注射吸毒者。目标2将纵向评估 炎症相关的生物标志物与脆弱的转变。目标3将确定可行性，并定义最佳的试验要素，为移动的健康（mHealth）增强运动干预，以改善老年艾滋病毒感染者的脆弱性参数。拟议的职业发展计划将通过以下领域的额外专业知识来扩展我的技术技能：（1）复杂纵向数据的过渡建模和分析;（2）移动健康技术在健康行为促进中的应用;（3）为资源有限，虚弱，老龄化的艾滋病毒感染者设计和实施身体活动干预措施。我将在约翰霍普金斯大学医学系得到很好的支持，并将受益于ALIVE研究和约翰霍普金斯大学其他中心和研究所的优秀研究基础设施。随着老龄化HIV感染人群生存率的提高和多发病风险的增加，HIV感染者老龄化的流行病学和生物学方面的研究已成为NIH的优先事项。虚弱是一种重要的年龄相关综合征，

DESCRIPTION (provided by applicant): My career goal is to improve health outcomes for aging HIV-infected and at risk communities and to support the development of health promoting interventions tailored to socially marginalized, resource-constrained, and clinically vulnerable members of these communities. Frailty is an important age-related state of increased vulnerability to stressors that results in early death and a wide range of adverse age-associated clinical outcomes including increased hospitalization, disability, and institutionalization. Consequently, frailty has been identified by the Institute of Medicine as a top target priority are for health care improvement in the U.S. Early data have suggested an increased occurrence of frailty among aging HIV-infected persons. The epidemiologic and biological factors that determine transitions between frailty states (frailty progression and recovery) are not well-characterized. The proposed studies are nested in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, representing aging, minority injection drug users (IDUs) at the greatest risk for frailty-related consequences. Aim 1 utilizes longitudinal ALIVE data to examine the role of HIV and multimorbidity on frailty progression and recovery among aging HIV-infected and epidemiologically comparable HIV-uninfected IDUs. Aim 2 will longitudinally assess the relationship of inflammation-related biological markers with frailty transitions. Aim 3 will determine the feasibilty and define optimal trial elements for a mobile health (mHealth) enhanced exercise intervention to improve frailty parameters among aging HIV-infected persons. The proposed career development plan will expand my technical skills through additional expertise in the following domains: (1) transition modeling and analysis of complex longitudinal data; (2) application of mHealth technologies to health behavior promotion; (3) design and implementation of physical activity interventions for resource-constrained, frail, aging HIV-infected persons. I will be well supported within the Department of Medicine at Johns Hopkins University and will benefit from the excellent research infrastructure of the ALIVE study and other centers and institutes at Johns Hopkins University. With increasing survival but increased risk of multimorbid disease among aging HIV-infected populations, research on the epidemiologic and biological aspects of aging with HIV have become an NIH priority. Frailty represents an important age-related syndrome of significant