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

摘要 在美国，超过25万名女性携带艾滋病毒，但针对身体健康的研究有限 以及感染艾滋病毒(WLHIV)的年轻女性的心理健康状况。因为中国的健康状况 生殖年限和周围怀孕严重影响终生健康，了解健康结果 在怀孕前、怀孕期间和怀孕后的育龄青年中，WLHIV对公共卫生具有实质性的影响 在美国和世界范围内的重要性。WLHIV的产妇结局与长期的 他们的孩子的健康和生存。儿科艾滋病毒/艾滋病队列研究(PHACS)，在21个地点进行 美国和波多黎各自2007年以来一直在跟踪育龄青年WLHIV及其子女， 有2000多名生母和2800名未感染艾滋病毒(HEU)的儿童。母亲有围产期 获得性艾滋病毒(PHIV)是特别令人感兴趣的，PHACS网络包括400名这样的艾滋病毒携带者 (WPHIV)和他们的251名HEU儿童。利用成功和长期的PHACS研究 基础设施和现有队列，我们将建立关于怀孕和暴露的健康结果 对于HIV/抗逆转录病毒药物(HOPE)队列，2000名怀孕、非怀孕或未分娩的WLHIV 生育年龄来自不同地理位置、艾滋病毒高发地区。利用PHACS，经济实惠 并将实现定向招生和跟踪纵向数据收集；我们还将建立 丰富的生物信息库，将WLHIV与其子女的数据和生物谱系联系起来。因此，希望研究 该平台将支持对年轻WLHIV的健康至关重要的高影响科学研究。 我们希望队列的科学目标是：(1)评估艾滋病毒相关疾病和治疗的效果 WLHIV患者生殖健康、非传染性疾病、口腔健康的影响因素及社会心理因素 这些健康结果的决定因素(参与护理、精神健康诊断、种族主义、不平等和 (2)评估儿童健康结果及其影响 关于WLHIV的健康，包括产妇艾滋病毒的疾病进展，抗逆转录病毒疗法的坚持， 参与护理和产妇心理健康。总体而言，希望将打造一个探索多层次的平台 影响WLHIV生殖期短期和长期健康的决定因素和机制 以及他们孩子的健康，并将作为未来#年多学科研究的资源。 例如遗传学和表观遗传学、微生物组/病毒体/蛋白质组和免疫激活等领域，以提供更好的 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.