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

项目摘要 多发病，即同一个体中两种或两种以上慢性疾病的共存，是一种全球性的突发疾病。 随着人口老龄化，个人和公共健康受到威胁。虽然一个人的平均预期寿命 艾滋病毒感染者已达到77岁，无合并症的年数比一般人群少16年。不仅 与年龄相关的慢性合并症在艾滋病毒中更常见，但发病时间要早十年， 不成比例地受到影响。尽管多病的影响降低了生活质量， 利用和成本，以及过早死亡率在艾滋病毒感染者中被放大，目前的艾滋病毒初级 《护理指南》没有专门针对多发病问题，也缺乏筛查和预防工具。在 MACS/WIHS联合队列研究（MWCCS），一项年龄> 12，000人的老年队列研究， 对HIV感染者进行了35年以上的随访，我们发现， 妇女的死亡率高于男子，特别是艾滋病毒感染者。我们还发现，接受治疗的人的多死亡风险 艾滋病病毒感染是由传统和艾滋病病毒相关因素介导的。这种以病人为导向的职业发展 应用程序建立在我们以前的工作，并将使用老年科学指导的方法来优化护理服务 和结果的老龄妇女和男子与艾滋病毒的风险过早的多次死亡在整个生命周期。的 总体概念框架优先考虑老龄化过程的研究，因为它影响多个（相对于 单一）共病以及这些共病如何聚集并具有共同的风险因素，因果关系 机制和/或影响。本研究的主要目的是：1）确定不同年龄组的 2）确定多发病集群和共同风险因素; 3）确定 微血管指标可预测多发性硬化状态的进展。我的长期职业目标是 成为一名独立资助的临床科学家，其工作重点是：1）确定多发病 艾滋病毒感染者整个生命周期的风险和影响，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。在此期间，我将由博士指导。 Igho Ofotokun，艾滋病毒终末器官损伤的翻译研究员; Anandi Sheth博士，艾滋病毒实施 具有女性健康专业知识的科学家; Solveig Cunningham博士，慢性病流行病学家; Leah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 具有干预专门知识的老年病医生-临床试验专家。完成概述的研究目标和 拟议的老年科学研究方法、先进的流行病学和生物统计学培训，包括潜在的 类分析和其他聚类分析技术，性/性别健康将显着提高我的能力， 为了实现我的职业目标，成为艾滋病并发症科学和妇女问题的独立研究人员， 健康埃默里大学提供了一个理想的合作环境，并提供强大的研究基础设施 以完成本申请表内所列的建议职业发展计划及导师研究计划。

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.