Prediction of heart failure in HIV-infected individuals

7.项目总结/摘要 在美国，一半的艾滋病毒感染者已经或即将超过50岁。心力衰竭，这是一个 在全国范围内，任何与年龄有关的疾病的最高疾病负担，可能很快成为最昂贵的艾滋病毒- 在过早死亡、痛苦和医疗保健支出方面的相关并发症。许多已知的 风险因素对艾滋病毒感染者和未感染者都是共同的，但对其 在抑制性HIV治疗的背景下的发病机制。新的证据表明，长期生存与 HIV与心脏收缩和舒张功能障碍以及由此导致的心力衰竭的更大风险相关， 射血分数降低（HFrEF）和射血分数保留的心力衰竭（HFpEF）。针对 糖尿病、高血压和肥胖风险高的少数群体的背景， 在HIV感染的背景下，可能存在一组独特的心力衰竭病因和预后因素HIV。 拟议的研究是一组流行病学研究，其特征是艾滋病毒感染在心力衰竭中的作用 发病率和存活率，基于纽约布朗克斯最大的HIV护理提供者的数据。目标1将评估 艾滋病毒感染与心力衰竭发病率之间的关系，目标1b将确定风险因素，包括 主要合并症，可能导致接受最佳治疗的HIV感染心力衰竭患者死亡率升高 与未感染艾滋病毒的心力衰竭患者相比。目标2和3将实现机器学习方法 在我们的纵向电子病历数据库中构建识别HIV+的预测模型， 最有可能发生HF的患者，并确定HFpEF的独特HIV特异性表型， HFrEF。在我们的临床人群（90%少数民族，40%女性）中开发的预测模型将在 在芝加哥的一个人口统计学上互补的HIV+队列（50%少数民族，15%女性）， 这些模型在患者人群中的可移植性。该奖项将提供充分的培训 候选人有机会继续他的独立学术研究生涯， 在艾滋病毒，心血管疾病和医学信息学的交叉专业经验。 建立了机构资源和一个具有成功记录的指导团队，以及研究 在艾滋病毒和心脏病流行的地理区域内进行，提供了一个理想的环境， 成功地进行了具有重大影响的高质量研究。该合作将建立一个计划， 通过建立一个共享的研究平台，在艾滋病毒和心力衰竭方面进行大规模的转化研究， 布朗克斯和芝加哥的两个主要研究机构。

7. PROJECT SUMMARY/ABSTRACT Half of those living with HIV in the U.S. are or will soon be >50 years of age. Heart failure, which has one of the highest disease burdens of any age-related condition nationwide, may soon become the most costly HIV- related comorbidity in terms of premature mortality, suffering, and healthcare expenditures. Many of its known risk factors are common to HIV-infected and uninfected individuals alike, but less is known about its pathogenesis in the context of suppressive HIV therapy. New evidence suggests that long-term survival with HIV is associated with greater risks for systolic and diastolic dysfunction as well as resultant heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Against a background of high diabetes, hypertension, and obesity risk in minority groups affected disproportionately by HIV, a unique set of etiologic and prognostic factors for heart failure in the context of HIV infection likely exists. The proposed research is a set of epidemiologic studies characterizing the role of HIV infection in heart failure incidence and survival, based on data from the largest HIV care provider in the Bronx, NY. Aim 1 will assess the association between HIV infection and heart failure incidence, and Aim 1b will identify risk factors, including major comorbidities, that may lead to greater mortality in optimally treated HIV-infected heart failure patients compared with HIV-uninfected heart failure patients. Aims 2 and 3 will implement machine learning methods within our longitudinal electronic medical record database to construct prediction models identifying HIV+ patients at greatest risk of developing HF, and to identify unique HIV-specific phenotypes of HFpEF and HFrEF. Prediction models developed in our clinical population (90% minority, 40% female) will be validated in a demographically complementary HIV+ cohort in Chicago (50% minority, 15% female) to evaluate the transportability of these models across patient populations. This award will provide ample training opportunities for the candidate to continue his progression to an independent academic research career with specialized experience at the intersection of HIV, cardiovascular disease, and medical informatics. Established institutional resources and a mentoring team with a proven record of success, as well as research conducted within a geographic area with endemic levels of HIV and heart disease, provide an ideal setting to successfully produce high quality research with major impact. The collaboration will establish a program for large-scale translational research in HIV and heart failure by developing a shared research platform between two major research institutions in the Bronx and Chicago.