Determinants of Resilience in Youth with HIV infection and Youth affected by HIV

描述(申请人提供)：全世界有330万名围产期感染艾滋病毒(paHIV+)的儿童携带艾滋病毒。PaHIV+和暴露于HIV但未感染(HEU)的青少年都面临认知和行为健康不良后果的风险。这些青年绝大多数生活在低收入和中等收入国家，仅在亚洲就有20多万艾滋病毒携带者和数百万高收入国家青年。随着有效抗逆转录病毒治疗的可获得性增加，新病例数量和儿童死亡率均有所下降。但是，提供者现在面临的挑战是满足越来越多幸存下来的年轻人的复杂需求，他们必须将艾滋病毒作为一种慢性、高度污名化和可传播的疾病来应对。在此基础上，我们将确定韧性的关键决定因素，定义为“青春期在面对不利环境时的认知、情绪和行为功能的能力”。我们的中心假设是，相对于他们的HEU同龄人，paHIV+的年轻人的能力将有所妥协，但在这两组人中，能力的关键决定因素都存在。我们利用NIH资助的预测研究中登记的paHIV+和HEU儿童的可用性，进行长达8年的临床、认知和神经成像随访。这项预测研究显示，与HEU和未暴露/未感染艾滋病毒的同龄人相比，3-15岁的paHIV+儿童的神经发育结果不太理想。随着儿童青春期的发展，监测执行功能的发展是至关重要的，包括决策、计划和自我调节，并了解额叶和其他大脑区域的发展，这些区域在一生中辅助执行功能。这项拟议的工作将检查较高的认知、执行、情绪和行为功能，并在修改后的社会行动理论(背景、社会调节和动机/能力因素)的指导下，确定PHIV+和HEU青少年的弹性决定因素。这项研究还将使用新技术来测量大脑体积和完整性，并特别关注前额叶皮质区域，以确定风险和韧性的神经解剖学相关性。此外，为了在全球范围内了解这一人群的需求，该研究将通过将结果数据与来自两个国家的类似数据集进行比较，来检查跨文化背景下弹性的决定因素。 美国和一名南非人。我们的长期目标是将关于复原力决定因素的知识转化为预防性干预措施，以促进全世界数百万艾滋病毒携带者和HEU青年的健康。

DESCRIPTION (provided by applicant): There are 3.3 million perinatally HIV-infected (paHIV+) children living with HIV worldwide. PaHIV+ and HIV-exposed but uninfected (HEU) youth are both at risk for adverse cognitive and behavioral health outcomes. The vast majority of these youth live in low- and middle-income countries (LMIC) with over 200,000 paHIV+ and millions of HEU youth in Asia alone. With increased availability of effective antiretroviral treatment, the number of new cases, as well as child mortality has both decreased. But, providers are now challenged to meet the complex needs of a growing number of surviving youth who must cope with HIV as a chronic, highly stigmatized, and transmittable illness. With this rationale, we will identify critical determinants for resilience, defined as "competence durin adolescence in cognitive, emotional and behavioral functioning in the face of adverse circumstances". Our central hypothesis is that paHIV+ youth will have compromised abilities relative to their HEU peers, but in both groups, critical determinants for competency will exist. We leverage the availability of paHIV+ and HEU children enrolled in the NIH-funded PREDICT study with up to 8 years of clinical, cognitive and neuroimaging follow-up. The PREDICT study showed less optimal neurodevelopment outcomes in paHIV+ ages 3-15 years compared to their HEU and HIV-unexposed/uninfected peers. As children progress through adolescence, it is critical to monitor the development of executive function, including decision making, planning, and self-regulation, and to understand the development of the frontal lobe and other brain areas that subserve executive function throughout life. This proposed work will examine higher cognition, executive, emotional and behavioral functioning, and identify the determinants of resilience in paHIV+ and HEU adolescents as guided by the modified social action theory (contextual, social regulation and motivation/capabilities factors). The study will also determine the neuroanatomical correlates for risk and resilience using novel techniques to measure brain volume and integrity with particular interest in the prefrontal cortex area. Moreover, in order to understand the needs of this population globally, the study will examine determinants of resilience across culturally settings by comparing the resulting data to similar data sets from two US and one South African cohorts. Our long-term goal is to translate knowledge on the determinants of resilience into preventive interventions that will promote health in millions of paHIV+ and HEU youth worldwide.