Health Outcomes around Pregnancy and Exposure to HIV/ARV (HOPE): Extending the Reach of PHACS to Examine Women's Health

摘要 美国有超过25万名妇女感染艾滋病毒，但有限的研究已经解决了身体上的问题。 和心理健康结果的年轻女性艾滋病毒感染者（WLHIV）。因为健康状况在 生育年龄和怀孕前后严重影响终身健康，了解健康结果 在怀孕前、怀孕期间和怀孕后的育龄妇女中， 在美国和世界范围内的重要性。WLVHIV的孕产妇结局与长期的 健康和儿童生存。儿科艾滋病毒/艾滋病队列研究（PHACS），在21个研究中心进行， 自2007年以来，美国和波多黎各一直在跟踪育龄妇女艾滋病毒携带者及其子女， 有超过2000名产妇和超过2800名艾滋病毒暴露的未感染儿童。围产期母亲 获得性艾滋病毒（PHIV）是特别感兴趣的，PHACS网络包括>400名患有PHIV的妇女 沿着他们的251名高浓缩铀儿童。利用成功和长期的PHACS研究 基础设施和现有队列，我们将建立围绕妊娠和暴露的健康结局 HIV/抗逆转录病毒药物（HOPE）队列，一个2000名孕妇、非孕妇或未经产的WLHIV患者队列， 来自不同地理位置、艾滋病毒高流行地区的育龄妇女。利用PHACS，经济高效 并将实现有针对性的招募和随访，以进行纵向数据收集;我们还将建立一个 将WLHIV与其子女的数据和生物标本联系起来。因此，HOPE研究 该平台将支持对年轻WLHIV健康至关重要的高影响力科学研究。 我们对HOPE队列的科学目标是：（1）评估HIV相关疾病和治疗的效果 生殖健康、非传染性疾病和WLHIV的口腔健康以及心理社会因素 这些健康结果的决定因素（参与护理、心理健康诊断、种族主义、不平等和 污名化、艾滋病毒的披露和物质使用/滥用），以及（2）评估儿童健康结果及其影响 关于WLHIV的健康，包括孕产妇艾滋病毒疾病进展，抗逆转录病毒治疗（ART）依从性， 参与护理和孕产妇心理健康。总的来说，希望将创建一个平台，探索多层次的 影响WLHIV在生殖过程中短期和长期健康的决定因素和机制 年，以及他们的孩子的健康，并将作为未来多学科研究的资源， 遗传学和表观遗传学、微生物组/病毒组/蛋白质组和免疫激活等领域， 了解与这些结果相关的潜在炎症和表观遗传过程。

Abstract Over 250,000 women in the United States are living with HIV, but limited research has addressed the physical and mental health outcomes among younger women living with HIV (WLHIV). Because health status in the reproductive years and surrounding pregnancy critically affects lifelong health, understanding health outcomes among young WLHIV of reproductive age before, during, and after pregnancy is of substantial public health importance in the US and worldwide. The maternal outcomes of WLHIV are inextricably linked to the long-term health and survival of their children. The Pediatric HIV/AIDS Cohort Study (PHACS), conducted at 21 sites across the US and Puerto Rico, has been following young WLHIV of reproductive age and their children since 2007, with over 2000 birth mothers and >2800 HIV-exposed uninfected (HEU) children. Mothers with perinatally acquired HIV (PHIV) are of specific interest, and the PHACS network includes >400 such women with PHIV (WPHIV) along with their 251 HEU children. Utilizing the successful and longstanding PHACS research infrastructure and existing cohorts, we will establish the Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) cohort, a cohort of 2000 pregnant, non-pregnant or nulliparous WLHIV of reproductive age from geographically diverse, high HIV prevalence areas. Leveraging PHACS, cost-effective and targeted enrollment and follow-up for longitudinal data collection will be achieved; we will also establish a rich biorepository which links WLHIV to their children’s data and biospecimens. Thus, the HOPE research platform will support high impact scientific studies central to the health of young WLHIV. Our scientific aims for the HOPE cohort are: (1) to evaluate the effects of HIV-related disease and treatment factors on reproductive health, non-communicable diseases, and oral health of WLHIV as well as psychosocial determinants of these health outcomes (engagement in care, mental health diagnoses, racism, inequity and stigma, disclosure of HIV, and substance use/misuse), and (2) To assess child health outcomes and their impact on the health of WLHIV, including maternal HIV disease progression, antiretroviral therapy (ART) adherence, engagement in care and maternal mental health. Overall, HOPE will create a platform to explore the multilevel determinants and mechanisms that influence the short and longer-term health of WLHIV during their reproductive years, as well as the health of their children, and will serve as a resource for future multidisciplinary studies in areas such as genetics and epigenetics, microbiome/virome/proteomes and immune activation, to provide better understanding of potential inflammatory and epigenetic processes associated with these outcomes.