Determinants and Consequences of Frailty among Aging HIV-infected Persons

描述(申请人提供)：我的职业目标是改善老年艾滋病毒感染者和高危社区的健康结果，并支持为这些社区的社会边缘化、资源受限和临床脆弱成员量身定做的健康促进干预措施的发展。虚弱是一种与年龄相关的重要状态，对应激源的易感性增加，导致过早死亡和一系列与年龄相关的不良临床结果，包括增加住院、残疾和住院。因此，虚弱已被美国医学研究所确定为改善美国医疗保健的首要目标。早期数据表明，老年艾滋病毒感染者中虚弱的发生率增加。决定脆弱状态之间转变的流行病学和生物学因素(脆弱、进展和恢复)尚未得到很好的描述。拟议的研究嵌套在与静脉注射经历(活的)队列有关的艾滋病患者中，代表着老年少数注射吸毒者(IDUs)面临与虚弱相关的后果的最大风险。目的1利用纵向活体数据来检查艾滋病毒和多发病在老年艾滋病毒感染者和老年患者中脆弱进展和恢复方面的作用 流行病学上可比的未感染艾滋病毒的注射吸毒者。目标2将纵向评估 具有脆弱转变的炎症相关生物标志物。目的3将确定移动健康(MHealth)增强运动干预的可行性并确定最佳试验要素，以改善老年艾滋病毒感染者的脆弱参数。拟议的职业发展计划将通过增加以下领域的专门知识来扩展我的技术技能：(1)复杂纵向数据的过渡建模和分析；(2)将移动健康技术应用于促进健康行为；(3)为资源有限、虚弱、老龄的艾滋病毒感染者设计和实施体力活动干预措施。我将在约翰·霍普金斯大学医学系得到很好的支持，并将受益于约翰·霍普金斯大学的Alive研究和其他中心和研究所的优秀研究基础设施。随着老年艾滋病毒感染人群存活率的提高，但多发病风险的增加，对艾滋病毒老龄化的流行病学和生物学方面的研究已成为NIH的优先事项。虚弱是一种重要的与年龄相关的综合征

DESCRIPTION (provided by applicant): My career goal is to improve health outcomes for aging HIV-infected and at risk communities and to support the development of health promoting interventions tailored to socially marginalized, resource-constrained, and clinically vulnerable members of these communities. Frailty is an important age-related state of increased vulnerability to stressors that results in early death and a wide range of adverse age-associated clinical outcomes including increased hospitalization, disability, and institutionalization. Consequently, frailty has been identified by the Institute of Medicine as a top target priority are for health care improvement in the U.S. Early data have suggested an increased occurrence of frailty among aging HIV-infected persons. The epidemiologic and biological factors that determine transitions between frailty states (frailty progression and recovery) are not well-characterized. The proposed studies are nested in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, representing aging, minority injection drug users (IDUs) at the greatest risk for frailty-related consequences. Aim 1 utilizes longitudinal ALIVE data to examine the role of HIV and multimorbidity on frailty progression and recovery among aging HIV-infected and epidemiologically comparable HIV-uninfected IDUs. Aim 2 will longitudinally assess the relationship of inflammation-related biological markers with frailty transitions. Aim 3 will determine the feasibilty and define optimal trial elements for a mobile health (mHealth) enhanced exercise intervention to improve frailty parameters among aging HIV-infected persons. The proposed career development plan will expand my technical skills through additional expertise in the following domains: (1) transition modeling and analysis of complex longitudinal data; (2) application of mHealth technologies to health behavior promotion; (3) design and implementation of physical activity interventions for resource-constrained, frail, aging HIV-infected persons. I will be well supported within the Department of Medicine at Johns Hopkins University and will benefit from the excellent research infrastructure of the ALIVE study and other centers and institutes at Johns Hopkins University. With increasing survival but increased risk of multimorbid disease among aging HIV-infected populations, research on the epidemiologic and biological aspects of aging with HIV have become an NIH priority. Frailty represents an important age-related syndrome of significant