Risk Factors for Abnormal Spirometry Among HIV+ Individuals in Nairobi, Kenya

肯尼亚内罗毕艾滋病毒感染者肺活量测定异常的危险因素

• 批准号: 8788893
• 负责人: Engi Farouk Attia
• 金额: $ 5.39万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8788893
• 关键词: 10 year old; Address; Adult; Age-Years; Biostatistical Methods; Bronchodilator Agents; Burn injury; CD4 Lymphocyte Count; Caring; Chronic; Chronic Disease; Chronic lung disease; Clinical; Clinical Investigator; Clinical Research; Clinical assessments; Collaborations; Communicable Diseases; Country; Data; Data Analyses; Data Collection; Databases; Developed Countries; Disease; Enrollment; Epidemiologic Methods; Evaluation; Exposure to; Forced expiratory volume function; Future; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Healthcare; Hospitals; Incidence; Individual; Infection; Kenya; Knowledge; Life; Lung; Lung diseases; Malnutrition; Measures; Medical; Morbidity - disease rate; Outcome; Oxygen; Patient Self-Report; Patients; Pattern; Play; Predictive Value; Prevalence; Public Health; Pulmonary Function Test/Forced Expiratory Volume 1; Pulse Oximetry; Questionnaires; Research Design; Research Infrastructure; Resources; Respiratory Signs and Symptoms; Respiratory physiology; Risk; Risk Factors; Role; Sensitivity and Specificity; Severity of illness; Smoking; Spirometry; Staging; Surface; Symptoms; Time; Tobacco; Tobacco smoke; Training; Universities; Vital capacity; Washington; World Health Organization; age related; antiretroviral therapy; cigarette smoking; cohort; disability; disorder risk; experience; improved; lung development; modifiable risk; mortality; public health relevance; respiratory; response; screening; tool; treatment program

DESCRIPTION (provided by applicant): Expanding access to antiretroviral therapy (ART) in resource-limited settings has resulted in prolonged survival for many HIV-infected (HIV+) individuals. As a consequence, chronic illness and aging-related disability are likely to increase as they have in cohorts of HIV+ individuals in developed countries. How this will impact lung health and the prevalence of chronic lung disease (CLD) among HIV+ individuals in resource-limited settings remains largely unknown. In developed countries, the incidence of infectious pulmonary complications of HIV has declined dramatically and CLD has surfaced as an increasingly important determinant of morbidity and mortality among HIV+ adults in the current ART era. In resource-limited countries where still proportionately fewer HIV+ individuals have access to ART, the extent to which a similar shift in pulmonary disease has occurred over the last 20 years has not been fully explored. Factors known to increase risk of CLD such as smoking tobacco may be less important in the developing world, and risk factors including vertically-acquired HIV, indoor biofuel burning and initiation of ART at lower CD4 cell counts may play more prominent roles. This project will evaluate risk factors for decreased lung function, measured using spirometry, to detect CLD among HIV+ individuals ¿10 years old who receive HIV-related medical care at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. The Hope Center was created in partnership with the University of Washington in 2004. Leveraging this established infrastructure and existing clinical research database, containing details of HIV disease stage and treatment, the applicant will collect standardized questionnaires and respiratory evaluations, including spirometry and pulse oximetry to achieve this project's specific aims, which are: 1) to determine risk factors for abnormal spirometry among HIV+ individuals and 2) to determine sensitivity, specificity and predictive value of a standardized assessment of self-reported respiratory symptoms, along with respiratory rate and oxygen saturation to identify HIV+ individuals with abnormal spirometry. To complete this project, the applicant will obtain formal training in advanced epidemiologic and biostatistical methods related to study design, data collection and analysis, and the responsible conduct of clinical research in resource-limited settings. This training and completion of this project will propel the applicant toward her goal of improving lung health in local and global settings as an independent clinical investigator, with a focus on HIV-related lung disease. This study will yield significant results that will enhance current knowledge of CLD risk factors among HIV+ individuals and identify modifiable risk factors that may be targeted in future studies to decrease the burden of CLD and its associated morbidity and mortality. In addition, clinical features of individuals at risk for abnormal spirometry will be identified and can be used to target future screening and improve treatment of these individuals in resource-limited settings.

描述（由申请人提供）：在资源有限的环境中扩大抗逆转录病毒治疗（ART）的可及性，延长了许多艾滋病毒感染者（HIV+）的生存期。因此，慢性病和与衰老有关的残疾可能会增加，就像发达国家艾滋病毒阳性人群中的情况一样。在资源有限的环境中，这将如何影响肺部健康和艾滋病毒阳性个体中慢性肺部疾病（CLD）的患病率在很大程度上仍然未知。在发达国家，HIV感染性肺部并发症的发病率已大幅下降，CLD已成为当前ART时代HIV+成人发病率和死亡率的一个日益重要的决定因素。在资源有限的国家中，获得抗逆转录病毒治疗的艾滋病毒阳性者比例仍然很低，过去20年来肺部疾病发生类似变化的程度尚未得到充分探讨。已知增加CLD风险的因素，如吸烟，在发展中国家可能不太重要，风险因素包括垂直获得的HIV，室内生物燃料燃烧和在较低的CD4细胞计数下开始ART可能发挥更突出的作用。 该项目将评估肺功能下降的风险因素，使用肺量测定法测量，以检测在肯尼亚内罗毕科普特希望传染病中心接受艾滋病毒相关医疗护理的10岁以下艾滋病毒阳性个体中的CLD。希望中心于2004年与华盛顿大学合作成立。利用这一已建立的基础设施和现有的临床研究数据库，其中包含艾滋病毒疾病阶段和治疗的详细信息，申请人将收集标准化问卷和呼吸评估，包括肺活量测定和脉搏血氧测定，以实现本项目的具体目标，即：1）确定HIV+个体中异常肺量测定的风险因素和2）确定敏感性，自我报告的呼吸道症状的标准化评估的特异性和预测价值，沿着呼吸频率和血氧饱和度，以识别肺功能异常的HIV阳性个体。为了完成该项目，申请人将获得与研究设计，数据收集和分析以及在资源有限的环境中负责任地进行临床研究相关的先进流行病学和生物统计学方法的正式培训。这个训练和完成这个项目将推动申请人朝着她的目标改善肺 作为一名独立的临床调查员，在当地和全球环境中开展健康研究，重点是艾滋病毒相关的肺部疾病。 这项研究将产生显著的结果，这将提高目前的知识CLD的风险因素之间的HIV+个人，并确定可修改的风险因素，可能是针对未来的研究，以减少CLD及其相关的发病率和死亡率的负担。此外，将确定存在肺功能测定异常风险的个体的临床特征，并可用于 以便在资源有限的情况下针对未来的筛查和改善对这些人的治疗。