An EYE toward healthy aging in HIV: building evidence for multimorbidity screening and prevention

项目总结 多发病，即两种或两种以上慢性疾病在同一个体中共存，是一种紧急的全球性疾病 随着人口老龄化，对个人和公共健康的威胁。而一个人的平均预期寿命 HIV已达77岁，无合并症年限比一般人群少约16岁。不仅是因为 与衰老相关的慢性合并症在艾滋病毒中更常见，但发病时间早于十年，而女性 受到不成比例的影响。尽管有多病的影响-生活质量下降，但更高的医疗保健 使用率和费用，以及过早死亡--艾滋病毒携带者中的放大，目前是艾滋病毒初级 护理指导没有具体解决多发病问题，而且缺乏筛查和预防工具。在……里面 MACS/WIHS联合队列研究(MWCCS)，一项对12,000名患有或面临糖尿病风险的老年人的队列研究 经过35年的随访，我们发现与年龄相关的合并症负担在 妇女多于男子，尤其是艾滋病毒携带者。我们还发现，接受治疗的人患多发性疾病的风险 感染艾滋病毒的原因既有传统因素，也有艾滋病毒相关因素。这种以病人为导向的职业发展 应用程序建立在我们之前的工作基础上，并将使用老年科学指导的方法来优化护理交付 以及老年艾滋病毒携带者在一生中有过早患多发病风险的结果。这个 总体概念框架优先研究衰老过程，因为它影响多个(而不是 单项)合并症以及这些合并症如何聚集并具有共同的风险因素，因果关系 机制和/或影响。拟议的目标包括：1)确定年龄相关的进化 多发病级联；2)确定多发病聚集性和共同的风险因素；3)确定 微血管指标可预测多发病状态的进展。我的长期职业目标是 成为一名独立资助的临床医生兼科学家，他的工作重点是：1)确定多病 艾滋病毒携带者一生中的风险和影响，以及2)将这些发现转化为针对性别的 促进健康老龄化的临床和公共卫生干预措施。在这个奖项中，我将得到博士的指导。 Igho Ofotokun，HIV末端器官损害的翻译研究员；Anandi Sheth博士，HIV实施 擅长妇女健康的科学家；慢性病流行病学家索尔维格·坎宁安博士；利亚博士 鲁宾，一位专注于认知健康模式和预测因素的神经科学家；卡米尔·沃恩博士，一位 老年病学家-具有干预专业知识的临床试验专家。完成概述的研究目标和 拟培训老年学研究方法、高级流行病学和生物统计学，包括潜伏期 班级分析和其他聚类分析技术，以及性/性别健康将显著增强我的能力 为了实现我的职业目标，成为一名艾滋病毒共病科学和妇女研究的独立研究员 健康。埃默里大学提供理想的协作环境，并提供强大的研究基础设施 完成本申请表中提出的职业发展计划和指导研究项目。

PROJECT SUMMARY Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is an emergent global threat to individual and public health as populations age. While the average life expectancy for a person with HIV has reached 77 years, comorbidity-free years are ~16 fewer than the general population. Not only are aging-related, chronic comorbidities more common in HIV, but onset is up to a decade earlier and women are disproportionately affected. Despite the impact of multimorbidity—reduced quality of life, higher healthcare utilization and cost, and premature mortality—being magnified among persons with HIV, current HIV Primary Care Guidance does not specifically address multimorbidity, and screening and prevention tools are lacking. In the MACS/WIHS Combined Cohort Study (MWCCS), an aging cohort of >12,000 persons with or at-risk of HIV with >35 years of follow-up, we showed that aging-related comorbidity burden was significantly higher in women than in men, particularly in persons with HIV. We also found that multimorbidity risk in treated persons with HIV was mediated by both traditional and HIV-related factors. This patient-oriented career development application builds on our prior work, and will use a geroscience-guided approach for optimizing care delivery and outcomes for aging women and men with HIV at risk of premature multimorbidity across the lifespan. The overarching conceptual framework prioritizes the study of the aging process as it affects multiple (as opposed to singular) comorbidities and how these comorbid conditions cluster and have shared risk factors, causal mechanisms, and/or impacts. The proposed Aims include: 1) To ascertain the age-specific evolution of multimorbidity cascades; 2) To identify multimorbidity clusters and shared risk factors; and 3) To determine if microvascular indicators predict the progression of multimorbidity status. My long-term career goal is to become an independently-funded clinician-scientist whose work is focused on: 1) ascertaining multimorbidity risk and impact across the lifespan of persons with HIV, and 2) translating these findings into sex-tailored clinical and public health interventions that promote healthy aging. During this Award, I will be mentored by Dr. Igho Ofotokun, a translational researcher in HIV end-organ damage; Dr. Anandi Sheth, an HIV implementation scientist with expertise in women’s health; Dr. Solveig Cunningham, a chronic disease epidemiologist; Dr. Leah Rubin, a neuroscientist focused on cognitive health patterns and predictors; and Dr. Camille Vaughan, a geriatrician-clinical trialist with interventions expertise. Completion of the outlined research Aims and the proposed training in geroscience research methods, advanced epidemiology and biostatistics including latent class analysis and other cluster analytic techniques, and sex/gender health will significantly enhance my ability to achieve my career goals to become an independent researcher in HIV comorbidity science and women’s health. Emory University offers an ideal collaborative environment and provides robust research infrastructure to complete the proposed career development plans and mentored research project outlined in this application.