Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH

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Abstract LSUHSC CARC Research Component 1: Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH Aging persons living with HIV (PLWH) are a vulnerable population at higher risk for chronic illnesses and geriatric syndromes (i.e., metabolic alterations, diabetes, cardiovascular disease, cancer, renal disease, and osteoporosis). Higher levels of both psychosocial and physiological stress among PLWH have also been associated with poorer immune status, increased viral load over time, faster disease progression, and higher rates of mortality. Comorbid conditions in PLWH can be further exacerbated by at-risk alcohol use; and PLWH are two to three times more at risk of alcohol use disorder (AUD). There is a critical need for a deeper understanding of the roles that social determinants at the community and interpersonal levels play in chronic comorbidities in PLWH. Neighborhoods and social spaces are important contexts through which social determinants act to shape health and health behavior. However, there is a fundamental gap in current scientific evidence-based knowledge about what people actually experience in these contexts, their impact on care for PLWH, and how they may interact with other drivers of sub-optimal care such as at-risk alcohol use and clinical comorbidities. Our preliminary data suggest a significant role of stress exposure at multiple levels on alcohol use outcomes and comorbidities. The objective of Research Component 1 (RC1) is to determine the impact of community and interpersonal stress on behavioral and chronic comorbidities among PLWH, and the unique role that alcohol use plays in the pathways. Our central hypothesis is that exposure to stressors at the community and interpersonal levels will impact clinical comorbidities, such as cardiometabolic and cognitive outcomes in PLWH, through impacts on alcohol use and additional behavioral and coping mechanisms. Our approach will involve the incorporation of individual level demographic and clinical data along with neighborhood data and interpersonal exposures from PLWH and HIV- adults. We will incorporate advance modeling techniques to determine the relation of individual, interpersonal, and community level measurable variables and latent constructs, testing longitudinally the mediation of the effects by alcohol consumption. We will also explore in depth individual space and time geographical momentary assessment (GMA) data collected from this cohort. RC1’s proposed research links basic science with behavioral and social sciences, to epidemiology to determine the role in alcohol in HIV-associated comorbidities. Our project will provide key data that will directly inform multilevel interventions to improve the health of minority communities and neighborhoods that continually sustain the biggest burden of HIV and associated comorbidities.