Perinatal HIV infection/exposure, stress and long-term functional survival in Ugandan adolescents

乌干达青少年围产期艾滋病毒感染/暴露、压力和长期功能生存

• 批准号: 9344996
• 负责人: AMARA E EZEAMAMA
• 金额: $ 20.38万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-20 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9344996
• 关键词: 18 year old; Academic achievement; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Area; Brain; Charge; Child; Childhood; Chronic; Cognitive; Cognitive deficits; Collaborations; Communities; Competence; Controlled Study; Data; Development; Disadvantaged; Distress; Emotional; Enrollment; Exposure to; Fatigue; Future; HIV; HIV Infections; HIV-infected adolescents; Health; Healthcare Systems; Highly Active Antiretroviral Therapy; Human; Iatrogenesis; Immunologic Deficiency Syndromes; Impaired cognition; Individual; Infection; Intervention; Investigation; Knowledge; Life; Life Cycle Stages; Link; Longitudinal Studies; Measures; Mediating; Mediator of activation protein; Nature; Neuronal Plasticity; Normal Range; Outcome; Pediatric HIV/AIDS Cohort Study; Perinatal; Perinatal Exposure; Persons; Physiological; Pilot Projects; Positioning Attribute; Premature Mortality; Principal Investigator; Property; Prophylactic treatment; Psychometrics; Quality of life; Quality-of-Life Assessment; Questionnaires; Recording of previous events; Regimen; School-Age Population; Social Development; Societies; Stream; Stress; Subgroup; Uganda; body system; clinically relevant; cognitive development; cognitive enhancement; cognitive function; cognitive testing; cohort; design; early childhood; executive function; fetal; functional disability; functional outcomes; functional status; in utero; innovation; instrument; novel; perinatal outcomes; postnatal; prevent; prophylactic; psychosocial; psychosocial adjustment; relating to nervous system; residence; resilience; self esteem; social; social stigma; stressor; success; transmission process

The long-term functional implication of in utero and postnatal highly active antiretroviral therapy (HAART) exposures for perinatally human immunodeficiency virus (HIV) exposed or infected children in school-age and beyond is unknown. Recent data from the US pediatric HIV/AIDS Cohort Study (PHACS) finds that perinatally HIV exposed and perinatally HIV infected children have cognitive test scores in the low range of normal but did not find significant cognitive deficit for HIV-exposed unexposed children with and without in utero HAART. Almost no data on this subject is available for children from sub-Saharan Africa where an estimated 1.4 million children per year are exposed to iatrogenic HAART during sensitive periods of neural, physical and social development. Perinatally HIV exposed or infected children contend with a steady stream of physiologic and psychosocial stressors in utero, early childhood and throughout their life course. These stressors occur during sensitive periods of development and may be associated with medium to long-term functional deficits. For example, academic achievement and psychosocial adjustment represent common standards by which individual success is measured in childhood and adolescence. Appropriate development in these areas is closely linked to overall academic attainment and future capacity to productively contribute to the society as an adult. For perinatally HIV infected adolescents, there is a simultaneous exectation that they progressively take charge of managing their chronic health condition through consistent adherence to HAART regimen and gaining competence in navigating the healthcare system. These capacities require a robust executive cognitive function and appropriate psychosocial adjustment. To inform knowledge gaps, and contribute new data on long-term differences in functional outcomes (i.e. cognitive development, psychosocial adjustment and quality of life) for perinatally HIV exposed and infected compared to perinatally HIV unexposed children, we evaluate HIV status related differences in functional outcomes in a cohort of 11-18 years old Ugandan children with and without perinatal HIV exposure/infection. We specifically assess psychosocial and physiologic stress – measured as a composite of dysregulations across multiple organ systems, as mediators of any HIV-related deficits in functional impairment. By design we distinguish between functional outcomes for HIV exposed or infected children in comparison to perinatally HIV unexposed children from the same community. This study is therefore positioned to provide a comprehensive and robust assessment of HIV specific impact on functional indicators in school-age and adolescence. Data arising from this investigation will inform the nature of possible remedial interventions required to optimize the long-term functional status of perinatally HIV exposed or infected children and adolescents.

子宫和产后高度活性抗逆转录病毒疗法的长期功能意义 （HAART）暴露于人类免疫缺陷病毒（HIV）暴露于暴露或感染的儿童 学龄及以后是未知的。美国儿科艾滋病毒/艾滋病队列研究的最新数据 （PHAC）发现暴露于周围的HIV和围产期HIV感染的儿童具有认知测试 正常范围较低但没有发现艾滋病毒暴露的明显认知缺陷的分数 在子宫内有和没有子宫内的未暴露儿童。几乎没有有关此主题的数据可用于 来自撒哈拉以南非洲的儿童，估计每年有140万儿童接触 在神经，身体和社会发展敏感时期，医源性HAART。 暴露或感染的儿童围产期艾滋病毒与稳定的生理学和 子宫内的社会心理压力源，幼儿和整个人生过程。这些压力源出现 在敏感的发展期间，可能与中长期功能有关 缺陷。例如，学术成就和社会心理调整代表共同标准 通过在儿童期和青少年中衡量个人成功。适当的发展 这些领域与整体学术成就和未来能力紧密相关，以富有成效地贡献 成年社会。对于围产期艾滋病毒感染的青少年，有一个简单的阶段 他们逐渐负责通过一致管理慢性健康状况 遵守HAART方案并在导航医疗系统方面具有能力。这些 能力需要强大的执行认知功能和适当的社会心理调整。 了解知识差距，并为功能的长期差异提供新数据 围产期艾滋病毒的结果（即认知发展，社会心理调整和生活质量） 与围产期HIV暴露的儿童相比，暴露和感染了，我们评估了HIV状况相关的 11-18岁的乌干达儿童有和没有，功能结果的差异 围产期HIV暴露/感染。我们专门评估心理和生理压力 - 测量 作为跨多器官系统失调的复合材料，作为任何与HIV相关缺陷的介体 在功能障碍中。通过设计，我们区分艾滋病毒暴露的功能结果或 与来自同一社区的围产期艾滋病毒接触儿童相比，受感染的儿童。这 因此，研究的定位是对HIV特定影响的全面评估 关于学龄和青少年的功能指标。这项调查产生的数据将告知 优化优化长期功能状态所需的补救干预措施的性质 围产期艾滋病毒暴露或感染的儿童和青少年。