Determinants and Consequences of Frailty among Aging HIV-infected Persons

描述（由申请人提供）：我的职业目标是改善老年艾滋病毒感染和风险社区的健康结果，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制的健康促进干预措施的发展。虚弱是一种重要的与年龄相关的状态，对压力源的脆弱性增加，导致早期死亡和广泛的与年龄相关的不良临床结果，包括住院、残疾和机构化的增加。因此，虚弱已被医学研究所确定为美国医疗保健改善的首要目标，早期数据表明，在老年艾滋病病毒感染者中，虚弱的发生率有所增加。决定衰弱状态（衰弱进展和恢复）之间转变的流行病学和生物学因素尚未得到很好的表征。拟议的研究嵌套在艾滋病与静脉注射经验（ALIVE）队列中，代表了老年人，少数注射吸毒者（IDUs）在虚弱相关后果的最大风险。目的1利用纵向ALIVE数据来检查艾滋病毒和多病在老年艾滋病毒感染者和艾滋病患者的虚弱进展和恢复中的作用

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