Unpacking the Mechanisms of Disparities for HIV-related Hypertension in African American and Asian Pacific American MSM

揭示非裔美国人和亚太裔 MSM 中 HIV 相关高血压差异的机制

• 批准号: 10022564
• 负责人: GRACE X. MA
• 金额: $ 12.5万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10022564
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; African American; American; Asian Americans; Asians; Behavior; Behavioral; Bisexual; Blood Pressure; CCL2 gene; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Cities; Clinical; Color; Comorbidity; Coronary Artery Risk Development in Young Adults Study; Data; Diagnosis; Discrimination; Disease Progression; Epidemic; Etiology; Exposure to; Fibrin fragment D; Gays; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; Health; Homophobia; Hypertension; IL8 gene; Immune; Individual; Inflammation; Inflammatory; Interleukin-6; Knowledge; Life; Literature; Longitudinal observational study; Measures; Mediating; Medicine; Modeling; Native Hawaiian; Outcome; P-Selectin; Pacific Island Americans; Philadelphia; Population; Positioning Attribute; Poverty; Prevalence; Psychosocial Factor; Research; Risk; Risk Factors; Science; Social isolation; Social support; Stress; Testing; Time; United States; Ursidae Family; age group; aged; cohort; coping; cytokine; ethnic discrimination; ethnic minority population; experience; health disparity; interdisciplinary approach; longitudinal design; male; men; men who have sex with men; men' s group; metropolitan; minority health; multidisciplinary; novel; protective factors; racial and ethnic; racial discrimination; racism; sex; social; substance misuse; surveillance data; tool

The literature reveals that hypertension (HTN) is considerably higher among HIV-positive individuals than HIV-negative individuals. However, the systemic/individual determinants (including behavioral, clinical, macro- social, and psychosocial factors) for this health co-morbidity is not fully understood in the literature. To fill these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD’s “Minority Health and Health Disparities Research Framework” -- to examine and elucidate the multiple determinants of HTN observed in two ethnic-sexual men who have sex with men (MSM) living with HIV/AIDS. To that end, we will address three specific aims and hypotheses: Aim 1: To examine the association of macro-social determinants (i.e., homophobia, racial/ethnic discrimination), behavioral risk factors (e.g., substance misuse), and psychosocial factors (e.g., stress) with HTN among a cohort of African American or AA (200 AA in Philadelphia) and Asian Pacific Americans or APA (200 APA in Honolulu) MSM living with HIV -- We hypothesize that greater exposure to homophobia and racial/ethnic discrimination is associated with a greater prevalence of HTN among HIV-positive MSM. Aim 2: To determine the underlying systemic/individual determinants which account for the relationship between inflammation and HTN over time, given common forms of hypertension have been postulated to be immune mediated -- We hypothesize that the greater exposure to homophobia and racial/ethnic discrimination is associated with dysregulation of pro-inflammatory cytokines (D-dimer, hsCRP, IL-6, IL-8, MCP-1, P-selectin), where they mediate HTN among these men. Aims 3: To examine whether associations between these factors and health outcomes are moderated by coping and social support -- We hypothesize that greater social support would mitigate HTN among these men. This is the first study that uses systemic/individual and multi-disciplinary approaches to examine the impact of multiple determinants on HTN co-morbidity over time among AA and APA MSM living with HIV. Our multi-disciplinary team with expertise in HIV prevention science, clinical HIV medicine, ethnic-sexual MSM, and chronic diseases are uniquely positioned to address risk and protective factors of multiple influences of HTN co-morbidity over time among AA and APA MSM with HIV. By conceptually and empirically testing novel hypotheses, we will provide evidence of etiology and validated tools and measures that advance our understanding of mechanisms of disparities in HIV-related co-morbidities. Findings from this longitudinal observational study will inform the management of HIV and its HTN co-morbidity as a chronic disease, especially among the two disparity groups of MSM (AA and APA) who continue to bear the burden of health disparities. This study is guided by NIMHD’s conceptual framework to address multiple influences of health disparities on HTN comorbidity among HIV-positive MSM disparity populations.

文献显示，高血压（HTN）是相当高的艾滋病毒阳性的个人比 艾滋病毒阴性者。然而，系统/个体决定因素（包括行为、临床、宏观、 社会和心理社会因素），因为这种健康共病在文献中没有得到充分的理解。填补 这些科学差距，我们建议使用纵向设计来系统地检查系统/个人 方法-模仿NIMHD的“少数民族健康和健康差异研究框架”- 检查并阐明在两名与男性发生性关系的种族性男性中观察到的HTN的多种决定因素。 男男性行为者（MSM）感染艾滋病毒/艾滋病。为此，我们将讨论三个具体目标和假设：目标1： 研究宏观社会决定因素的关联（即，同性恋恐惧症、种族/族裔歧视）， 行为风险因素（例如，物质滥用）和心理社会因素（例如，压力）与HTN之间 非裔美国人或AA（费城200名AA）和亚太裔美国人或阿帕（费城200名阿帕）队列 檀香山）艾滋病毒感染的男男性接触者--我们假设，更多地接触同性恋恐惧症和种族/民族 在HIV阳性的男男性行为者中，歧视与HTN的更高患病率相关。目标2：确定 解释炎症和炎症之间关系的潜在全身/个体决定因素 HTN随着时间的推移，鉴于常见的高血压形式已被假定为免疫介导的-我们 假设更多地接触同性恋恐惧症和种族/民族歧视与以下因素有关： 促炎性细胞因子（D-二聚体、hsCRP、IL-6、IL-8、MCP-1、P-选择素）的失调， 在这些人中间调解HTN。目的3：研究这些因素与健康之间的关系 结果受到应对和社会支持的调节--我们假设更大的社会支持会 减轻这些人的HTN。这是第一个使用系统/个人和多学科的研究， 研究AA患者中多种决定因素随时间推移对HTN合并症的影响的方法， 艾滋病病毒感染者的生活我们的多学科团队在艾滋病毒预防科学，临床艾滋病毒 医学，种族性MSM和慢性病是独特的定位，以解决风险和保护 AA和阿帕MSM HIV感染者中HTN共病随时间变化的多重影响因素。通过 我们将从概念上和经验上检验新的假设，提供病因学的证据和有效的工具 和措施，促进我们对艾滋病毒相关的并发症的差异机制的理解。 这项纵向观察性研究的结果将为HIV及其HTN共病的管理提供信息 作为一种慢性疾病，特别是在两个不同的MSM群体（AA和阿帕）中，他们继续承担 健康差距的负担。这项研究是由NIMHD的概念框架，以解决多个 HIV阳性MSM差异人群健康差异对HTN共病的影响