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

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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.