Project 3 - Impairment and multimorbidity among people aging with HIV and ART in South Africa

项目3：南非艾滋病毒和抗逆转录病毒疗法感染者的损害和多重死亡- 摘要 抗逆转录病毒疗法（ART）的益处和副作用正在从根本上改变年龄 南非是世界上艾滋病毒感染者最多的国家， 全球艾滋病毒感染者和接受抗逆转录病毒治疗的人数。衰老的艾滋病毒感染者可能会遭受大量的 认知障碍和痴呆、身体障碍和多病。这些缺陷和 由于长期影响， 艾滋病毒感染;长期ART的副作用;以及社会心理，行为和结构 PLHIV的特征南非健康、老龄化和痴呆症项目3的研究： 纵向研究（HAALSI）提案将填补对健康、老龄化和社会问题至关重要的知识空白。 南非的政策：认知障碍的人口水平频率、类型和驱动因素， 南方艾滋病高流行社区艾滋病感染者中的痴呆、身体损伤和多发病 和南部非洲。为了做到这一点，我们将在以前的HAALSI艾滋病毒更新项目的基础上， MRC/Wits农村公共卫生和卫生转型研究单位（Agincourt）之间的伙伴关系， 哈佛人口与发展研究中心。首先，我们将量化全国流行的 认知和身体损害在南非整个艾滋病毒护理连续使用既定的认知 电池和身体功能测试在HAALSI全国调查。我们还将量化 认知和身体损害的年龄过程和艾滋病毒护理连续使用纵向 HAALSI阿金库尔队列。第二，我们将确定不同的人老化的多模态配置文件， 南非的艾滋病毒和ART，使用生物标志物、人体测量学和认知和 关于一系列疾病和病症的心理数据，包括艾滋病毒、高血压、糖尿病、肥胖症， 高胆固醇血症和高胆固醇血症、抑郁症和认知障碍和痴呆。三是 将利用准实验方法来确定艾滋病毒和ART的长期影响以及 老年艾滋病病毒感染者认知功能障碍的社会心理、行为和结构特征，包括 痴呆症;身体损伤;和南非的慢性多发性硬化症。我们的研究将提供 设计确保健康和有尊严的老龄化的政策和计划所急需的证据 在南非和更广泛的南部非洲， 非洲区域。

Project 3: Impairment and multimorbidity among people aging with HIV and ART in South Africa – Abstract The benefits and side effects of antiretroviral therapy (ART) are fundamentally changing the age composition and multimorbidities of people living with HIV (PLHIV) in South Africa, which has the largest number of both PLHIV and people receiving ART globally. Aging PLHIV are likely to suffer from substantial cognitive impairment and dementia, physical impairment, and multimorbidities. These impairments and morbidities are likely distinct from those that people without HIV suffer from – because of the long-term effects of HIV infection; the side effects of long-term ART; and the psychosocial, behavioral, and structural characteristics of PLHIV. The research in Project 3 of the Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI) proposal will fill a knowledge gap that is critical for health, aging, and social policy in South Africa: the population-level frequencies, types, and drivers of cognitive impairment and dementia, physical impairment, and multimorbidity among PLHIV in HIV hyperendemic communities in South and Southern Africa. To do this, we will build on the previous HAALSI HIV renewal project, and the successful partnership between the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and the Harvard Center for Population and Development Studies. First, we will quantify the national prevalence of cognitive and physical impairment across the HIV care continuum in South Africa using established cognitive batteries and physical function tests in the HAALSI National survey. We will also quantify the changes in cognitive and physical impairment across the age course and the HIV care continuum using the longitudinal the HAALSI Agincourt cohort. Second, we will identify the distinct multimorbidity profiles of people aging with HIV and ART in South Africa, using clustering analyses of biomarker, anthropometric, and cognitive and psychological data on a range of diseases and conditions, including HIV, hypertension, diabetes, obesity, hypercholesterolemia and hypertriglyceridemia, depression, and cognitive impairment and dementia. Third, we will utilize quasi-experimental methods to establish the long-term effects of HIV and ART as well as the psychosocial, behavioral, and structural characteristics of older PLHIV on cognitive impairment including dementia; physical impairment; and chronic multimorbidity in South Africa. Our research will provide the evidence that is critically needed to design policies and programs that will ensure healthy and dignified aging among the large and growing population of older adults with HIV in South Africa and the broader Southern African region.