Environmental Lead Exposure and Premature Aging among Adolescents Living with HIV in Haiti

海地艾滋病毒感染者的环境铅暴露和过早衰老

• 批准号: 10872098
• 负责人: JEAN WILLIAM PAPE
• 金额: $ 10万
• 依托单位: GHESKIO CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-22 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10872098
• 关键词: Acceleration; Address; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Aging; Albumins; Area; Blood Pressure; Case/Control Studies; Chronic; Clinic; Communities; Creatinine; Creatinine clearance measurement; Diastolic blood pressure; Environmental Epidemiology; Environmental Exposure; Epidemic; Epidemiology; Equation; Foundations; Goals; HIV; HIV-infected adolescents; Haiti; Improve Access; Infection; Interview; Lead levels; Life Cycle Stages; Measures; Medicine; Mentors; Outcome; Parents; Participant; Population; Postdoctoral Fellow; Premature aging syndrome; Prevalence; Process; Research; Research Methodology; Research Support; Research Training; Services; Severities; Source; Surveys; Training; Training Support; United States National Institutes of Health; Universities; Urine; Youth; adolescent health outcomes; blood lead; blood pressure elevation; career; cohort; comorbidity; cost effectiveness; critical developmental period; environmental Pb exposure; improved; kidney dysfunction; lead exposure; parent grant; pre-clinical; prevent; programs; scale up; social; success; therapy design; training project

Project Summary: The goal of this supplement’s parent grant is to improve HIV-related health outcomes of adolescents (10-19 years) and youth (20-24 years) in Haiti. A major emphasis is on research-training to extend adolescent HIV services from the clinic to the community. Evidence demonstrates that providing services in the community improves access, social acceptability, cost-effectiveness, and ultimately large-scale impact. The parent program builds on the foundation established in Haiti during three decades of NIH research and training support to Groupe Haitien d-Etude du Sarcome et des Infections Opportunistes (GHESKIO) and Weill Cornell Medicine (WCM) to address the adolescent HIV epidemic in Haiti. Dr. Elsie Jean is a post-doctoral research fellow and in the proposed mentored research training project, she will establish the prevalence of elevated blood lead levels (BLLs) among adolescents and young adults living with HIV (AYALH) in Haiti. Further, she will explore the association between BLL and signs of premature aging including kidney dysfunction and elevated blood pressure. Haiti has alarmingly high lead levels documented in adults, and our research at GHESKIO indicates 42% of AYALH have elevated blood pressure. We hypothesize lead exposure during the early and critical developmental period of adolescence could be a driver of premature aging which will only progress in severity across the life-course. Dr. Jean will also explore sources of environmental lead exposure in order to design interventions to prevent or mitigate exposure. Dr. Jean’s career goal is to conduct research to improve the long-term outcomes of AYALH and prevent chronic co-morbidities that may undermine the success of global ART scale-up. Her objective is to identify and eliminate environmental exposures that may accelerate or exacerbate the aging process among AYALH in order to prevent premature aging. Dr. Jean will expand her training and build expertise in three areas: 1) environmental epidemiology, 2) CVD epidemiology among HIV-infected populations, and 3) mixed methods research. She will complete her MPH at Quisqueya University and 3 intensive short-courses. She will also participate in regular research- in-progress presentations in the GHESKIO-Weill Cornell Fogarty Research Seminar. Dr. Jean’s research plan leverages two established cohorts in Haiti. Among participants in the Adolescent HIV Preclinical CVD Cohort, she will measure BLLs in 500 AYALH and compare the prevalence to a cohort of HIV-uninfected adolescents and young adults in the Haiti CVD Cohort. She will measure the association of elevated BLLs with elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) (mmHg) (> 120/80) and renal dysfunction (urine albumin to creatinine ratio (ACR) >30 mg/g or creatinine clearance (eGFR mL/min/1.73 m2 using CKD-Epi equation)). In a case-control study, she will conduct in-depth interviews and targeted surveys among 20 AYALH with elevated BLLs and 20 without to explore sources of exposure.

项目概述：该补助金的父母补助金的目标是改善艾滋病毒相关的健康结果， 海地的青少年（10-19岁）和青年（20-24岁）。一个主要重点是研究培训， 将青少年艾滋病毒服务从诊所扩大到社区。有证据表明， 社区服务改善了可获得性、社会可接受性、成本效益，并最终实现大规模 冲击该母项目建立在美国国立卫生研究院三十年来在海地建立的基础之上 并向海地肉瘤和机会感染研究小组（GHESKIO）提供培训支持， 威尔康奈尔医学（WCM），以解决海地青少年艾滋病毒流行。 Elsie Jean博士是一名博士后研究员，在拟议的指导研究培训项目中， 她将确定青少年和年轻人中血铅水平升高的患病率， 艾滋病毒感染者（AYALH）。此外，她将探讨BLL和 过早衰老包括肾功能障碍和血压升高。海地以惊人的领先优势 在成人中记录的水平，我们在GHESKIO的研究表明，42%的AYALH有升高的血液 压力我们假设铅暴露在青春期的早期和关键发育期 可能是过早衰老的驱动因素，而过早衰老的严重程度只会在整个生命过程中不断加剧。吉恩医生会 还探索环境铅接触的来源，以设计干预措施， 减少暴露。Jean博士的职业目标是进行研究，以改善 AYALH和预防可能破坏全球ART扩大成功的慢性合并症。她 目标是识别和消除可能加速或加剧老化的环境暴露 为了防止过早衰老，在AYALH中进行了一个过程。 Jean博士将扩大她的培训，并在三个领域建立专业知识：1）环境流行病学，2） HIV感染人群中CVD流行病学; 3）混合方法研究。她将完成 她在Quisqueya大学获得硕士学位，并参加了3个强化短期课程。她还将参加定期研究- 在GHESKIO-Weill Cornell Fogarty研究研讨会上进行的演讲。 Jean博士的研究计划利用了海地的两个既定队列。在青少年中， HIV临床前CVD队列，她将测量500名AYALH患者的BLL，并将其患病率与 海地CVD队列中未感染艾滋病毒的青少年和年轻人。她将测量 BLL升高伴收缩压（SBP）和舒张压（DBP）升高（mmHg）（> 120/80）和肾功能不全（尿白蛋白与肌酸酐比率（ACR）>30 mg/g或肌酸酐清除率（eGFR mL/min/1.73 m2，使用CKD-Epi方程））。在病例对照研究中，她将进行深入访谈， 在20名BLL升高的AYALH和20名没有BLL的AYALH中进行有针对性的调查，以探索暴露源。