URBAN ARCH (5/5) Boston Cohort - Alcohol and HIV-associated comorbidity and complications: Frailty, Functional impairment, Falls, and Fractures (the 4F study)

URBAN ARCH (5/5) 波士顿队列 - 酒精和 HIV 相关合并症和并发症：虚弱、功能障碍、跌倒和骨折（4F 研究）

• 批准号: 9545618
• 负责人: RICHARD SAITZ
• 金额: $ 65.33万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9545618
• 关键词: AIDS/HIV problem; Accident and Emergency department; Acute; Address; Affect; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Body Weight decreased; Boston; Cessation of life; Clinical; Cohort Studies; Collaborations; Comorbidity; Complication; Development; Disease; Drug usage; Elderly; Emergency department visit; Fall prevention; Fracture; HIV; HIV Infections; HIV risk; Hepatitis C co-infection; High Prevalence; Hospitalization; Illicit Drugs; Impairment; Inflammation; Injury; Intervention; Intervention Studies; Knowledge; Lead; Mediating; Mediation; Morbidity - disease rate; Nature; Neuropathy; Opioid; Osteopenia; Osteoporosis; Osteoporotic; Outcome; Pharmaceutical Preparations; Phenotype; Physical Function; Play; Polypharmacy; Population; Premature aging syndrome; Preventive Intervention; Recovery; Research; Research Priority; Risk; Risk Factors; Role; Russia; Substance Use Disorder; Testing; Translating; Uganda; United States National Institutes of Health; Viremia; Walking; alcohol and other drug; alcohol consequences; alcohol exposure; alcohol research; antiretroviral therapy; base; cohort; cost; exhaustion; experience; fall risk; falls; frailty; functional disability; grasp; health care service utilization; high risk; illicit drug use; improved outcome; inflammatory marker; microbial; middle age; mortality; prevent; systematic review; therapy development; virology

Up to a third of middle-aged people living with HIV infection (PLWH) experience falls each year. Falls are the most common cause of non-fatal injury in the US and the cost from emergency department visits and hospitalizations are enormous. PLWH are more susceptible to falls and their serious consequences because 1) despite control of HIV viremia, inflammation persists and underlies HIV-associated comorbidities and complications that occur at a relatively young age (so-called premature aging), 2) specific comorbidities (e.g. neuropathy, osteoporosis) and complications (e.g. frailty and impaired physical function) make falls more likely and recovery from them more difficult, 3) alcohol use exacerbates inflammation, and may increase risk for comorbidities and complications, and 4) alcohol use, illicit drug use and polypharmacy can increase the likelihood of a fall. Despite this, fall prevention has not been extensively studied among PLWH. We need interventions to address falls in PLWH but none have been tailored for this population. Understanding risk factors and targets for intervention among PLWH are essential; cohort studies can provide the information needed for intervention development. This proposal is part the Consortia for HIV/AIDS and Alcohol-Related Research Trials (CHAART). It describes the continuation and expansion of a cohort that is one of three in the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH). The URBAN ARCH theme is to address consequences of alcohol use on HIV-associated comorbidities and complications to increase treatment availability and improve outcomes. In line with that theme we propose to continue to follow and expand (to 400) an existing cohort of PLWH and a high prevalence of exposure to alcohol, illicit drugs, and polypharmacy (the Boston ARCH Cohort) in the Frailty, Functional impairment, Falls, and Fractures (4F study) to: (in 2 Primary Aims) 1) Test the associations between alcohol (and illicit drugs and polypharmacy) and falls (fractures secondarily); and 2) Test the associations between alcohol (and illicit drugs and polypharmacy) and acute healthcare utilization (emergency department use and hospitalization for falls and fractures). We will also examine the role frailty plays in these associations between alcohol, drugs and medications and the aforementioned clinical and utilization outcomes. In Exploratory Aims we will test associations between alcohol use and inflammatory markers, and between markers and HIV-associated complication outcomes (4Fs); and develop and pilot test the feasibility of a falls prevention intervention tailored to address the identified risk factors (e.g. alcohol, illicit drugs, polypharmacy) in this population. By achieving these aims we will gain substantially greater understanding of these comorbidities and complications in PLWH exposed to alcohol and other psychoactive substances; this knowledge will serve to inform the development of ways to identify, prevent and manage falls, fractures, frailty and functional impairment.

每年有多达三分之一的中年艾滋病毒感染者（PLWH）经历福尔斯。福尔斯是 美国非致命伤害的最常见原因和急诊科就诊的费用， 住院治疗是巨大的。PLWH更容易受到福尔斯及其严重后果的影响，因为1） 尽管HIV病毒血症得到控制，但炎症仍然存在，是HIV相关合并症的基础， 在相对年轻的年龄发生的并发症（所谓的过早衰老），2）特定的合并症（例如， 神经病变、骨质疏松症）和并发症（如虚弱和身体功能受损）使福尔斯 可能和恢复从他们更困难，3）酒精使用加剧炎症，并可能增加风险 合并症和并发症，以及4）酒精使用，非法药物使用和多种药物可以增加 可能性下降。尽管如此，跌倒预防尚未在PLWH中得到广泛研究。我们需要 采取干预措施，解决艾滋病毒/艾滋病感染者福尔斯下降的问题，但没有一项针对这一人群。理解风险 在艾滋病毒携带者中进行干预的因素和目标是必不可少的;队列研究可以提供信息 需要进行干预发展。 该提案是艾滋病毒/艾滋病和酒精相关研究试验联盟（CHAART）的一部分。它 描述了一个队列的延续和扩大，这是在乌干达俄罗斯波士顿酒精三个之一， 艾滋病毒/艾滋病酒精研究合作网络。城市的主题是 解决饮酒对艾滋病毒相关合并症和并发症的影响，以增加治疗 可用性和改善结果。根据这一主题，我们建议继续遵循和扩大（ 400)现有的艾滋病毒携带者队列和酒精、非法药物和多种药物暴露的高患病率 (the波士顿队列）在虚弱、功能障碍、福尔斯和骨折（4F研究）中的比例：（2例主要 目的）1）测试酒精（和非法药物和多种药物）和福尔斯（骨折）之间的联系 其次）;和2）测试酒精（和非法药物和多种药物）和急性 医疗保健利用（急诊室使用和因福尔斯和骨折住院）。我们还将 研究脆弱在酒精、毒品和药物之间的联系中所起的作用， 上述临床和使用结果。在探索性目标中，我们将测试 酒精使用和炎症标志物，以及标志物和HIV相关并发症结局之间的关系 (4Fs);并制定和试点测试专门针对以下问题的福尔斯预防干预措施的可行性 该人群中已确定的风险因素（如酒精、非法药物、多种药物）。通过实现这些目标，我们 将更深入地了解暴露于以下物质的PLWH中的这些合并症和并发症： 酒精和其他精神活性物质;这方面的知识将有助于制定方法， 识别、预防和管理福尔斯、骨折、虚弱和功能障碍。