The Impact of Hearing Loss Treatment Scale-Up in Persons Aging with HIV on Dementia Risk, Quality of Life, and Healthcare Costs

项目总结 当接受抗逆转录病毒疗法(ART)治疗时，艾滋病毒携带者(PWH)的预期寿命类似于 未感染艾滋病毒但仍因慢性炎症等原因而增加患多发病风险的人 原因。与没有感染艾滋病毒的人相比，PWH的痴呆症发病率增加了两倍。vt.给出 由于缺乏实质性改变痴呆症病程的治疗方法，痴呆症的预防至关重要 重要性。 最近的证据表明，听力损失是痴呆症的主要可预防原因，多达8%的人 全世界所有的痴呆症都可能是由于听力损失。听力损失在PWH中很常见，最多可达5岁 比没有感染艾滋病毒的人早几年。此外，新出现的数据表明，助听器可以 大大降低因听力损失而增加的痴呆症风险。尽管存在潜在的 在改善生活质量和痴呆症风险、听力损失治疗方面，PWH的接受率仍然较低。 只有20%的听力损失者使用助听器，威尔斯亲王可能会面临更多的困难 助听器技术给健康、保险不足和其他不利的社会决定因素 医疗保健的结构性障碍。鉴于艾滋病毒携带者中听力损失和痴呆症的沉重负担， 听力损失的筛查和治疗在这一人群中可能特别重要。 在父母R01(R01AG069575)中，Emily Hyle博士和她的研究团队详细介绍了开发和 为老龄化的艾滋病毒人群建立痴呆症和多发病的模拟模型 (认知障碍、艾滋病毒、衰老、心脏、心理健康和痴呆症)模型。在这个管理部门中 作为补充，研究小组将整合现有的、经过验证的听力损失自然病史模型和 治疗，终身听力损失负担的决策模型(DeciBHAL)，与 很高兴能扩展多病模型的能力。然后团队将使用更新的Charmed 预测听力损失筛查和扩大治疗的有效性和成本效益的模型 在老化的威尔斯亲王医院中。该模型将预测老年威斯康星患者患痴呆症的风险潜在降低，这是由于 听力损失筛查和治疗。该项目的结果将为未来的临床试验、临床实践、 以及护理艾滋病毒老年患者的卫生政策指南。

PROJECT SUMMARY When treated with antiretroviral therapy (ART), persons with HIV (PWH) are living life expectancies similar to persons without HIV but remain at increased risk for multimorbidity due to chronic inflammation among other causes. PWH experience a two-fold increase in dementia incidence compared with persons without HIV. Given the absence of treatments to substantially alter the course of dementia, dementia prevention is of critical importance. Recent evidence suggests that hearing loss is a leading preventable cause of dementia and that up to 8% of all dementia worldwide may be due to hearing loss. Hearing loss is common among PWH and occurs up to five years earlier than among persons without HIV. Further, emerging data have shown that hearing aids could substantially mitigate the increased risk of dementia due to hearing loss. Despite the potential for improvements in quality of life and dementia risk, hearing loss treatment uptake among PWH remains low. Only 20% of persons with hearing loss use hearing aids, and PWH may face increased difficulties accessing hearing aid technology given disadvantageous social determinants of health, underinsurance, and other structural barriers to care. Given the high burden of hearing loss and dementia among people aging with HIV, hearing loss screening and treatment may be especially important in this population. In the parent R01 (R01AG069575), Dr. Emily Hyle and her research team detailed methods for developing and populating a simulation model of dementia and multimorbidity for the aging HIV population, the CHARMED (Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia) model. In this administrative supplement, the research team will integrate an existing, validated model of hearing loss natural history and treatment, the Decision model of the Burden of Hearing loss Across the Lifespan (DeciBHAL), with the CHARMED to expand the capacity for multimorbidity modeling. The team will then use the updated CHARMED model to project the effectiveness and cost-effectiveness of hearing loss screening and treatment scale-up among aging PWH. The model will project the potential reduction in dementia risk among aging PWH due to hearing loss screening and treatment. The results of this project will inform future clinical trials, clinical practice, and health policy guidelines for the care of persons aging with HIV.