HIV and musculoskeletal frailty: implications for care, policy and research

艾滋病毒和肌肉骨骼脆弱：对护理、政策和研究的影响

基本信息

批准号：
10686114
负责人：
Elena Losina
金额：
$ 85.92万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-18 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10686114
关键词：
Address Age Age Years Aging Attenuated Body Weight decreased Budgets Cardiovascular Diseases Cardiovascular system Caring Cessation of life Chronic Clinical Clinical Management Computer Simulation Consequences of HIV Cost Effectiveness Analysis Data Diagnosis Economics Effectiveness of Interventions Epidemic Exercise Exposure to Fall prevention Fatigue Fracture General Population Goals Guidelines HIV Hand Strength Health Benefit Hepatitis C co-infection Incidence Individual Infection Inflammation Intervention Knowledge Life Expectancy Medical Care Costs Metabolic syndrome Methodology Methods Modeling Muscle function Musculoskeletal National Institute of Arthritis, and Musculoskeletal, and Skin Diseases Natural History Opportunistic Infections Osteoporosis Outcome Output Persons Pharmaceutical Preparations Physical activity Physical assessment Physicians Policies Policy Analysis Policy Maker Polypharmacy Population Prevalence Prevention program Prevention strategy Process Quality-Adjusted Life Years RNA Recurrence Research Resources Series Structure Substance Use Disorder Time Tobacco Tobacco use Translating Translational Research United States antiretroviral therapy cardiovascular fitness comorbidity cost cost effective cost effectiveness cost estimate disability effective intervention exercise intervention exercise program experience fall risk falls frailty immune function improved innovation insight interest intervention cost large datasets models and simulation multi-component intervention multidisciplinary prevent programs reduced muscle mass response routine screening sarcopenia screening societal costs treatment guidelines treatment strategy walking speed years of life lost

项目摘要

The broad objective guiding our research is to provide critical insights to clinicians and decision makers regarding the value of interventions to diagnose, prevent and reduce progression of physical frailty (PF) in people with HIV (PWH). More than a million persons in the United States live with HIV, a previously fatal infection that has become a highly treatable chronic condition with the use of antiretroviral therapy. The life expectancy of PWH now approaches that of the general population, revealing an earlier than expected and growing prevalence of PF. PF carries substantial individual and societal burden. If unmanaged, it may lead to loss of independence, recurrent falls, fractures, disability, and death. Routine screening and management of PF has not been part of the treatment guidelines, which instead focused on opportunistic infections early in the HIV epidemic, and more recently on HCV co-infection, CVD, and tobacco and other substance use disorder. The challenges in diagnosing and managing PF and its associated conditions in PWH are further exacerbated by the gap between ‘what we know’ and ‘what we do.’ Evidence indicates that pre-frailty and early stages of PF are reversible with timely diagnosis and effective interventions. However, this evidence has not been translated to routine HIV care. Regular frailty assessment is essential to prevent falls, fractures and other consequences, yet most PWH have not been assessed for PF. Evidence also suggests that multimodal interventions including cardiovascular and strength exercise in conjunction with fall prevention, treatment of osteoporosis, and careful medication de-escalation are effective in reducing musculoskeletal manifestations of PF. There are similar benefits for PWH, however this evidence has not been translated into routine HIV care. Guidance on choosing among effective interventions to maximize health benefits for PWH with constrained budgets is lacking. Knowledge of the cost-effectiveness (value) and budgetary impact of these programs would help facilitate translation of research findings into clinical management of PWH. Cost-effectiveness analysis is an important methodology that helps to inform choice among multiple efficacious programs when resources including data, time, and money are limited. We propose to develop a computer simulation model that portrays the natural history and treatment of PF in PWH to narrow the gap between evidence and practice by assessing the value of three major strategies to prevent and attenuate progression of PF in PWH: 1) timely diagnosis of PF; 2) implementation of structured strengthening and cardiovascular fitness improvement exercise programs to reduce falls and fractures and prevent PF incidence and slow its progression; and 3) use of fall prevention programs, including polypharmacy de-escalation, osteoporosis screening and diagnosis and management to reduce falls and fractures.

指导我们的研究的广泛目标是为临床医生和决策者提供关键见解关于诊断，预防和减少身体脆弱进展（PF）的干预措施的价值艾滋病毒（PWH）的人。美国有超过一百万的人患有艾滋病毒，这是一种先前致命的感染，已成为一种使用抗逆转录病毒疗法的高度可治疗的慢性病。现在PWH的预期寿命接近普通人群，揭示了PF的预期比预期的和日益增长的患病率。承担重大的个人和社会负担。如果不受管理，它可能导致失去独立性，经常性瀑布，骨折，残疾和死亡。 PF的常规筛查和管理尚不参与相反最近，关于HCV共同感染，CVD和烟草以及其他药物使用障碍。诊断和管理PF及其相关状况的挑战进一步加剧了通过“我们所知道的”和“我们做什么”之间的差距。证据表明PF的杂费和早期阶段及时的诊断和有效的干预措施是可逆的。但是，这些证据尚未翻译例行艾滋病毒护理。常规的脆弱评估对于防止跌倒，裂缝和其他后果至关重要，然而，大多数PWH尚未评估PF。证据还表明，多模式干预措施包括心血管和力量运动与秋季预防，骨质疏松症的治疗和仔细的治疗药物降低可有效减少PF的肌肉骨骼表现。有相似的 PWH的好处，但是这些证据尚未转化为常规的艾滋病毒护理。选择指南在有效的干预措施中，缺乏预算有限的PWH最大化健康益处。了解这些计划的成本效益（价值）和预算影响将有助于促进将研究结果转换为PWH的临床管理。成本效益分析是一种重要的方法，有助于为多种高效的选择提供信息包括数据，时间和金钱在内的资源时的程序受到限制。我们建议开发一台计算机模拟模型描绘了PWH中PF的自然历史和处理以缩小差距通过评估预防和减轻三种主要策略的价值来证据和实践 PWH中的PF：1）及时诊断PF； 2）实施结构化加强和心血管适应性改进运动计划，以减少跌倒和骨折，并防止PF事件并减慢其速度进展； 3）使用秋季预防计划，包括多药降低，骨质疏松症筛查，诊断和管理，以减少跌倒和骨折。