Baltimore Oral Epidemiology, Disease Effects, and HIV Evaluation Study (BEEHIVE)

自从抗逆转录病毒疗法(ART)问世以来，艾滋病毒携带者(PLWH)的预期寿命 在美国稳步增长。PLWH现在更有可能发展为与年龄无关的共病 传染性疾病(NCDs)比同龄艾滋病毒非感染者更多，发病率和 非传染性疾病和年龄相关疾病的死亡率是最重要的。多重非传染性疾病的年龄调整率较高 与艾滋病毒阴性者相比，PLWH患者中的这一比例更高。此外，PLWH的患病率更高 口腔疾病的严重程度，特别是与牙周组织有关的疾病，尽管解释这些的因素 差距仍然不明朗。例如，艾滋病毒相关免疫抑制或病毒血症是主要原因吗？ 这些不同之处？生活方式因素和获得牙科保健是重要的决定因素吗？是 PLWH中的微生物组特征是独一无二的，它会随着时间的推移而变化吗？自1988年以来，艾滋病与 静脉注射体验(ALIVE)研究成功地跟踪了一名低收入人群，主要是非洲人 美国有注射吸毒史的艾滋病毒感染者和高危人群(PWID) 巴尔的摩以社区为基础的队列。三十多年来，Alive一直是事故风险因素的特征 艾滋病毒与艾滋病或死亡的进展，描述了危险行为的模式，确定了最佳艾滋病毒的障碍 并提供了对残疾人中艾滋病毒的自然和治疗过程的重要见解。近年来， Alive已经过渡到探索衰老对艾滋病毒的影响，重点是表型和器官特异性 非传染性疾病(例如，肝、肺、心血管、骨、肾、神经认知和 代谢性非传染性疾病)。拟议的项目利用Alive平台，重点关注艾滋病毒的综合影响 以及非传染性疾病在求医、临床和微生物层面对口腔健康的影响。的具体目标 拟议项目是：1)确定艾滋病毒状况在多大程度上影响获得和利用口腔 卫生保健服务；2)确定艾滋病毒状况对自我报告和临床口腔健康状况的影响程度； 3)确定艾滋病毒状况在多大程度上影响牙周炎的进展；以及4)确定对什么影响 艾滋病毒状况对牙周炎相关口腔微生物组签名的影响程度。前三个具体目标 包括确定共患非传染性疾病在多大程度上充当效果修饰剂的子目标。具体目标4，一 子目标描述了艾滋病毒对口腔微生物群的影响程度，第二个子目标定义了 口腔微生物组特征的纵向变化影响牙周炎的进展。为了实现这些目标， 我们在一年两次的活体研究访问的基础上，通过访谈、临床检查和生物显微镜组件， 并辅之以病历审查和登记联系。这些目标的关键影响是阐明 社会和个人层面的机制，确定可更改的风险因素，并产生新的见解以提供信息 在巴尔的摩和全国对PLWH进行有效和有针对性的口腔健康干预。

Since the advent of antiretroviral therapy (ART), the life expectancy of persons living with HIV (PLWH) has steadily increased in the United States. PLWH are now more likely to develop co-morbid age-related non- communicable diseases (NCDs) than are similarly-aged HIV-uninfected persons, and the morbidity and mortality of NCD and age-related conditions is paramount. The age-adjusted rates of multiple NCDs are higher among PLWH than among persons who are HIV negative. In addition, PLWH experience higher prevalence and severity of oral diseases, particularly related to the periodontium, although the factors that explain these disparities remain unclear. For example, is HIV-related immune suppression or viremia primarily responsible for these differences? Are lifestyle factors and access to dental care important determinants? Is the microbiome signature in PLWH unique and does it change over time? Since 1988, the AIDS Linked to the Intravenous Experience (ALIVE) study has successfully followed a lower-income, predominantly African American population of HIV-infected and at-risk persons with a history of injecting drugs (PWID) in a community-based cohort in Baltimore. Over three decades, ALIVE has characterized risk factors of incident HIV and progression to AIDS or death, described patterns of risk behaviors, identified barriers to optimal HIV care, and provided important insights into the natural and treated course of HIV among PWID. In recent years, ALIVE has transitioned to exploring the impact of aging with HIV, focusing on phenotypes and organ-specific non-communicable diseases (NCD) (e.g., liver, lung, cardiovascular, bone, kidney, neurocognitive and metabolic NCDs). The proposed project leverages the ALIVE platform to focus on the combined effects of HIV and NCDs on oral health at the health care-seeking, clinical, and microbiological levels. The specific aims of the proposed project are to: 1) determine to what extent HIV status influences access to and utilization of oral health care services; 2) determine to what extent HIV status affects self-reported and clinical oral health status; 3) determine to what extent HIV status influences the progression of periodontitis; and 4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. The first three specific aims include sub-aims that define the extent to which comorbid NCDs act as effect modifiers. For specific aim 4, one sub-aim describes the extent to which HIV influences the oral microbiome and a second sub-aim defines how longitudinal changes in the oral microbiome signature affect periodontitis progression. To achieve these aims, we build upon biannual ALIVE study visits with interview, clinical examination, and biospecimen components, supplemented by medical record review and registry linkages. The key impact of these aims is to illuminate social and individual-level mechanisms, identify modifiable risk factors, and produce novel insights to inform efficient and targeted oral health interventions for PLWH in Baltimore and nationally.