Interventions for Symptom Management in Older Patients with HAND

 描述（由申请人提供）：拟议的工作将解决60岁以上艾滋病毒感染患者的症状管理，这些患者正在接受联合抗逆转录病毒治疗（cART）和抑制病毒载量，但仍继续经历艾滋病毒相关神经认知障碍（HAND）的行为和认知症状。越来越重要的是，尽管有cART，HAND仍然存在，影响30-50%的老年艾滋病毒感染者。在这种情况下，辅助治疗的治疗试验失败了，包括旨在增加cART的中枢神经系统渗透有效性（CPE）的策略。患者遭受的症状普遍影响日常功能和生活质量;然而，这些患者目前缺乏治疗选择。在本申请中，我们提出，老年艾滋病毒感染者的认知障碍是一种老年综合征--一种临床表现， 一种不适合谨慎地归入疾病类别的状况，因为它是由一种以上的疾病过程驱动的，并且在老年时发生的频率更高。为了响应PA-13-210，我们提出了一项基于正念减压（MBSR）的随机对照评估，以针对60岁以上患有HAND并已最大化治疗选择的患者的注意力、压力、焦虑和抑郁症状。我们将采用静息状态功能磁共振成像的内在连接网络（ICN）分析，以证明与改善症状相对应的大脑网络强度增加。我们将量化社交网络和社交网络的感知强度，以确定它们是否会缓和我们的主要发现。这项工作结合了老年医学、神经科学和补充医学学科，以减少老年艾滋病毒感染患者的症状负担。

 DESCRIPTION (provided by applicant): The proposed work will address symptom management for patients over age 60 who are living with HIV- infection, are on combination antiretroviral therapy (cART) with suppressed viral loads, and yet continue to experience behavioral and cognitive symptoms of HIV-associated neurocognitive disorders (HAND). It is increasingly relevant that HAND persists despite cART, impacting between 30-50% of elders living with HIV. Treatment trials for adjuvant therapies in such a setting have failed, including strategies aimed at increasing central nervous system penetration effectiveness (CPE) of cART. Patients suffer symptoms that are pervasive in their impact on everyday functioning and quality of life; yet these patients are currently left with a dearth of treatment options. In this applicaton, we propose that cognitive impairment in elders living with HIV is a geriatric syndrome - a clinical condition that does not fit discreetly into a disease category because it is driven by more than one disease process and occurs with greater frequency in old age. In response to PA-13-210, we propose a randomized controlled evaluation of Mindfulness Based Stress Reduction (MBSR) to target attention, stress, anxiety, and depressive symptoms among patients over age 60 who have HAND and have maximized treatment options. We will employ intrinsic connectivity network (ICN) analyses of resting state functional magnetic resonance imaging to demonstrate increased strength of brain networks corresponding to improved symptoms. We will quantify social networks and perceived strength of social networks to determine if they moderate our main findings. Together this work employs geriatric, neuroscience and complementary medicine disciplines to reduce the symptom burden in aging HIV-infected patients.