Risk and mechanisms of neurocognitive impairment in older HIV-infected Hispanics

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 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) continues to be highly prevalent and debilitating in human immunodeficiency virus (HIV) infection, particularly among older persons. Hispanics are the fastest growing segment of the older adult population in the U.S., they are disproportionately represented among cases of HIV infection, and they are at elevated risk for NCI in both HIV and older age, separately. Yet, NCI among older HIV-infected Hispanics has not been examined. This Mentored Career Development Award (K23) application is designed to develop the applicant's skills to become an independent and culturally proficient clinical scientist investigating the role of risk factors for the development of NCI associated wit combined HIV infection and aging among Hispanics. The application contains a targeted research project to examine NCI in older HIV-infected Hispanics (primarily of Mexican origin/descent) and key factors driving ethnic differences in NCI associated with HIV and aging. Elucidation of psychosocial and biomedical factors that might lead to ethnic differences in NCI is a foundational step in developing targeted, culturally-relevant interventions to improve or minimize NCI, and thus reduce health disparities in this subpopulation. Among the many potential predictors of NCI, we focus on a set of potentially modifiable health behaviors that are particularly problematic among Hispanics, namely use of health services and personal practices associated with a healthy lifestyle (i.e., diet, and physical and cognitive activity). We also aim o examine some of the biomedical factors that might mediate the association of these health behaviors with NCI, including HIV disease burden and metabolic syndrome. Recognizing that Hispanics are a heterogeneous group, the research component of the present proposal focuses primarily on Hispanics of Mexican origin/descent, who are the largest Hispanic subgroup in the U.S. In support of the research proposal and the candidate's long-term goals, the comprehensive proposed training program builds on the applicant's background in clinical neuropsychology, as well as clinical research on cognitive aging and the neuropsychology of HIV, to gain key neuroAIDS knowledge (i.e. neuroAIDS disparities, and the intersection of HIV and aging), clinical research skills of particular relevance for cross-cultural studies (i.e. biostatistics, bioethics, and community engagement), as well as leadership and scientific communication skills. The multidisciplinary mentoring team includes expertise in all aspects of this proposal including neuroAIDS disparities (Primary Mentor: Dr. Robert Heaton; Co-mentor: Mara Luisa Zuniga; Consultant: Mariana Cherner; Collaborator: Dr. Mario de la Rosa); the intersection of aging and HIV (Co-Mentor: Dr. Dilip Jeste) including neuromedical implications (Consultant: Dr. Ronald Ellis); and cross-cultural psychometrics and biostatistics (Dr. Heaton and Consultants: Drs. Dan Mungas and Florin Vaida), bioethics (Dr. Zuniga), and community engagement (Dr. Zuniga). The present proposal will capitalize primarily on the University of California San Diego infrastructure, including the HIV Neurobehavioral Research Program, the Sam and Rose Stein Institute for Research on Aging, the Division of Global Public Health, and the Clinical and Translational Research Institute. It will also leverage expertise at the Universit of California Davis, and Florida International University. The excellent mentoring team and robust infrastructure will provide critical support to the applicant to successfully complete her training goals. This key training and new experience in executing the proposed research plan, along with her past clinical and research experiences and her Hispanic background will place her in a unique position to conduct highly impactful research that will serve the needs of a growing, underserved and vulnerable segment of the U.S. population.