Unpacking the Mechanisms of Disparities for HIV-related Hypertension in African American and Asian Pacific American MSM

揭示非裔美国人和亚太裔 MSM 中 HIV 相关高血压差异的机制

• 批准号: 9897219
• 负责人: GRACE X. MA
• 金额: $ 70.32万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9897219
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; African American; American; Asian Americans; Asians; Behavior; Behavioral; Bisexual; Blood Pressure; CCL2 gene; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Cities; Clinical; Color; Comorbidity; Coronary Artery Risk Development in Young Adults Study; Data; Diagnosis; Discrimination; Disease Progression; Epidemic; Etiology; Exposure to; Fibrin fragment D; Gays; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; Health; Homophobia; Hypertension; IL8 gene; Immune; Individual; Inflammation; Inflammatory; Interleukin-6; Knowledge; Life; Literature; Longitudinal observational study; Measures; Mediating; Medicine; Modeling; Native Hawaiian; Outcome; P-Selectin; Pacific Island Americans; Philadelphia; Population; Positioning Attribute; Poverty; Prevalence; Psychosocial Factor; Research; Risk; Risk Factors; Science; Social isolation; Social support; Stress; Testing; Time; United States; Ursidae Family; age group; aged; cohort; coping; cytokine; ethnic discrimination; ethnic minority population; experience; health disparity; interdisciplinary approach; longitudinal design; male; men; men who have sex with men; men' s group; metropolitan; minority health; multidisciplinary; novel; protective factors; racial and ethnic; racial discrimination; racism; sex; social; substance misuse; surveillance data; tool

The literature reveals that hypertension (HTN) is considerably higher among HIV-positive individuals than HIV-negative individuals. However, the systemic/individual determinants (including behavioral, clinical, macro- social, and psychosocial factors) for this health co-morbidity is not fully understood in the literature. To fill these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD’s “Minority Health and Health Disparities Research Framework” -- to examine and elucidate the multiple determinants of HTN observed in two ethnic-sexual men who have sex with men (MSM) living with HIV/AIDS. To that end, we will address three specific aims and hypotheses: Aim 1: To examine the association of macro-social determinants (i.e., homophobia, racial/ethnic discrimination), behavioral risk factors (e.g., substance misuse), and psychosocial factors (e.g., stress) with HTN among a cohort of African American or AA (200 AA in Philadelphia) and Asian Pacific Americans or APA (200 APA in Honolulu) MSM living with HIV -- We hypothesize that greater exposure to homophobia and racial/ethnic discrimination is associated with a greater prevalence of HTN among HIV-positive MSM. Aim 2: To determine the underlying systemic/individual determinants which account for the relationship between inflammation and HTN over time, given common forms of hypertension have been postulated to be immune mediated -- We hypothesize that the greater exposure to homophobia and racial/ethnic discrimination is associated with dysregulation of pro-inflammatory cytokines (D-dimer, hsCRP, IL-6, IL-8, MCP-1, P-selectin), where they mediate HTN among these men. Aims 3: To examine whether associations between these factors and health outcomes are moderated by coping and social support -- We hypothesize that greater social support would mitigate HTN among these men. This is the first study that uses systemic/individual and multi-disciplinary approaches to examine the impact of multiple determinants on HTN co-morbidity over time among AA and APA MSM living with HIV. Our multi-disciplinary team with expertise in HIV prevention science, clinical HIV medicine, ethnic-sexual MSM, and chronic diseases are uniquely positioned to address risk and protective factors of multiple influences of HTN co-morbidity over time among AA and APA MSM with HIV. By conceptually and empirically testing novel hypotheses, we will provide evidence of etiology and validated tools and measures that advance our understanding of mechanisms of disparities in HIV-related co-morbidities. Findings from this longitudinal observational study will inform the management of HIV and its HTN co-morbidity as a chronic disease, especially among the two disparity groups of MSM (AA and APA) who continue to bear the burden of health disparities. This study is guided by NIMHD’s conceptual framework to address multiple influences of health disparities on HTN comorbidity among HIV-positive MSM disparity populations.

文献显示，HIV 阳性个体的高血压 (HTN) 发病率明显高于艾滋病毒阳性个体。 HIV 阴性个体。然而，系统/个体决定因素（包括行为、临床、宏观） 文献中尚未充分理解这种健康共病的社会和心理社会因素。填补 针对这些科学差距，我们建议使用纵向设计来系统地检查系统/个体 方法——根据 NIMHD 的“少数族裔健康和健康差异研究框架”建模—— 检查并阐明在两名与性行为者发生性关系的种族男性中观察到的 HTN 的多重决定因素 感染艾滋病毒/艾滋病的男性 (MSM)。为此，我们将提出三个具体目标和假设： 目标 1： 检查宏观社会决定因素的关联（即恐同症、种族/民族歧视）， 高血压的行为风险因素（例如药物滥用）和社会心理因素（例如压力） 非裔美国人或 AA（费城 200 个 AA）和亚太裔美国人或 APA（费城 200 个 APA）群体 檀香山）感染艾滋病毒的男男性行为者——我们假设更多地接触恐同症和种族/族裔 歧视与 HIV 阳性 MSM 中 HTN 患病率较高有关。目标 2：确定 解释炎症和炎症之间关系的潜在系统/个体决定因素 随着时间的推移，高血压的常见形式被认为是免疫介导的——我们 假设更多地接触同性恋恐惧症和种族/民族歧视与 促炎细胞因子（D-二聚体、hsCRP、IL-6、IL-8、MCP-1、P-选择素）失调， 在这些人中调解 HTN。目标 3：检验这些因素与健康之间是否存在关联 结果受到应对和社会支持的调节——我们假设更大的社会支持会 减轻这些男性的高血压。这是第一项使用系统/个体和多学科的研究 方法来检查多种决定因素对 AA 和 APA MSM 感染艾滋病毒。我们的多学科团队在艾滋病毒预防科学、临床艾滋病毒方面拥有专业知识 医学、种族性 MSM 和慢性病在应对风险和保护方面具有独特的地位 AA 和 APA MSM 感染 HIV 期间 HTN 合并症的多重影响因素。经过 从概念上和经验上测试新的假设，我们将提供病因学证据和经过验证的工具 以及增进我们对艾滋病毒相关合并症差异机制的理解的措施。 这项纵向观察研究的结果将为 HIV 及其 HTN 并发症的管理提供信息 作为一种慢性疾病，特别是在继续承受压力的两个差异悬殊的 MSM 群体（AA 和 APA）中 健康差异的负担。这项研究以 NIMHD 的概念框架为指导，旨在解决多个问题 健康差异对 HIV 阳性 MSM 差异人群中 HTN 合并症的影响。