Developing a Risk Index for Functional Decline in Middle-Aged and Older Adults with HIV

项目摘要/摘要 随着艾滋病病毒携带者(PWH)进入老年，人们越来越有必要每天保存公共卫生 在老化的PWH中起作用。PWH经历不成比例的不利因素，包括神经认知 与年龄相关的损害(NCI)和精神疾病(如抑郁症)和内科(如糖尿病)共病- 没有艾滋病毒的可比同龄人。这些因素加在一起，使老年PWH面临日常功能下降的风险。 尽管如此，关于日常功能变化的长期模式和相关性的研究很少 在PWH中，没有由这种纵向数据提供信息的有效的多变量风险指标。因此， 这个F31的研究目标将描绘出威斯康星医院日常功能的独特纵向轨迹； 并基于纵向建模开发并初步验证了不利和保护因素的风险指数 以确定威斯康星有功能衰退的风险。该项目将在一个 加州大学圣地亚哥分校(UCSD)艾滋病毒神经行为跨学科导师团队 研究计划(HNRP)，一个领先的研究中心，拥有艾滋病毒和老龄化方面的专家。拟议的F31将 利用访问两项档案纵向研究：CNS HIV抗逆转录病毒治疗效果研究 (Charge；N=704)和HIV感染成人多维度成功老龄化(N=106)， 是在国家核方案进行和/或协调的。因此，具体目标是：1)识别唯一 发展数据集中的日常运行轨迹(宪章)；2a)开发预测模型，使用 开发数据集中功能下降的不利预测因素；2b)在 开发(宪章)和验证(成功老化)数据集；以及3)确定是否积极 心理因素增加了预测功能衰退的价值。培训计划提出 在开发日常功能的高级纵向预测模型方面进行了严格的统计培训， 结合具体指导，了解和使用与衰老有关的生物、心理和社会变量 PWH作为潜在的预测指标。这份F31申请符合美国国家老龄研究所(NIA)的使命 支持和开展关于老龄化的生物学、临床、行为和社会研究；除了他们的使命之外 促进科研和临床科研人员在老龄化中发展。它也与美国国立卫生研究院办公室的 艾滋病研究(OAR)优先考虑经过充分验证的多变量指数，这些指数结合了一系列生物学和 行为测量，以预测哪些PWH是不良后果的高危人群。提供的机会 通过这一F31机制将有助于申请者的专业发展成为 独立的学术神经心理学家，致力于促进老年威斯康星医院的成功衰老。

PROJECT SUMMARY/ABSTRACT As people with HIV (PWH) enter older adulthood, there is a growing public health need to preserve everyday functioning in aging PWH. PWH disproportionately experience adverse factors including neurocognitive impairment (NCI) and psychiatric (e.g., depression) and medical (e.g., diabetes) comorbidities relative to age- comparable peers without HIV. Together, these factors put older PWH at risk for everyday functioning decline. Despite this, there are few studies on the longer-term patterns and correlates of everyday functioning change in PWH, and there is no well-validated multivariable risk index informed by such longitudinal data. Therefore, the research aims of this F31 will delineate unique longitudinal trajectories of everyday functioning in PWH; and develop and initially validate a risk index of adverse and protective factors based on longitudinal modeling to identify PWH at risk for functional decline. This project will be conducted with support from an interdisciplinary mentorship team at the University of California, San Diego (UCSD) HIV Neurobehavioral Research Program (HNRP), a leading research center with experts in HIV and aging. The proposed F31 will leverage access to two archival longitudinal studies: CNS HIV Antiretroviral Therapy Effects Research (CHARTER; N = 704) and Multi-Dimensional Successful Aging Among HIV-Infected Adults (N = 106), that were conducted and/or coordinated at the HNRP. Accordingly, the specific aims are to: 1) identify unique everyday functioning trajectories in a development dataset (CHARTER); 2a) develop a prediction model using adverse predictors for functional decline in the development dataset; 2b) validate the model in the development (CHARTER) and validation (Successful Aging) datasets; and 3) determine if positive psychological factors add incremental value to predicting functional decline. The training plan proposes rigorous statistical training in developing advanced longitudinal predictive models of everyday functioning, combined with specific mentoring in the understanding and uses of biopsychosocial variables relevant to aging PWH as potential predictors. This F31 application is in line with the National Institute of Aging’s (NIA) mission to support and conduct biological, clinical, behavioral, and social research on aging; in addition to their mission to foster the development of research and clinician scientists in aging. It is also in line with an NIH Office of AIDS Research (OAR) priority for well-validated, multivariable indices that combine a range of biological to behavioral measures to predict which PWH are at high-risk for adverse outcomes. The opportunities afforded via this F31 mechanism will facilitate the applicant’s professional development toward becoming an independent academic neuropsychologist dedicated to promoting successful aging among older PWH.