URBAN ARCH (5/5) Boston Cohort - Alcohol and HIV-associated comorbidity and complications: Frailty, Functional impairment, Falls, and Fractures (the 4F study)

URBAN ARCH (5/5) 波士顿队列 - 酒精和 HIV 相关合并症和并发症：虚弱、功能障碍、跌倒和骨折（4F 研究）

• 批准号: 9205414
• 负责人: RICHARD SAITZ
• 金额: $ 65.8万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9205414
• 关键词: AIDS/HIV problem; Accident and Emergency department; Accounting; Acute; Address; Affect; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Body Weight decreased; Boston; Cessation of life; Clinical; Cohort Studies; Collaborations; Comorbidity; Complication; Development; Disease; Drug usage; Elderly; Emergency department visit; Fall prevention; Fracture; HIV; HIV Infections; HIV risk; Hepatitis C co-infection; High Prevalence; Hospitalization; Illicit Drugs; Impairment; Inflammation; Injury; Intervention; Intervention Studies; Knowledge; Lead; Life; Mediating; Mediation; Morbidity - disease rate; Nature; Neuropathy; Opioid; Osteopenia; Osteoporosis; Osteoporotic; Outcome; Pharmaceutical Preparations; Phenotype; Physical Function; Play; Polypharmacy; Population; Premature aging syndrome; Preventive Intervention; Recovery; Research; Research Priority; Risk; Risk Factors; Role; Russia; Substance Use Disorder; Testing; Translating; Uganda; United States National Institutes of Health; Viremia; Walking; alcohol and other drug; alcohol exposure; alcohol research; antiretroviral therapy; base; cohort; cost; exhaustion; experience; falls; frailty; functional disability; grasp; health care service utilization; high risk; illicit drug use; improved outcome; inflammatory marker; microbial; middle age; mortality; prevent; systematic review; therapy development

Up to a third of middle-aged people living with HIV infection (PLWH) experience falls each year. Falls are the most common cause of non-fatal injury in the US and the cost from emergency department visits and hospitalizations are enormous. PLWH are more susceptible to falls and their serious consequences because 1) despite control of HIV viremia, inflammation persists and underlies HIV-associated comorbidities and complications that occur at a relatively young age (so-called premature aging), 2) specific comorbidities (e.g. neuropathy, osteoporosis) and complications (e.g. frailty and impaired physical function) make falls more likely and recovery from them more difficult, 3) alcohol use exacerbates inflammation, and may increase risk for comorbidities and complications, and 4) alcohol use, illicit drug use and polypharmacy can increase the likelihood of a fall. Despite this, fall prevention has not been extensively studied among PLWH. We need interventions to address falls in PLWH but none have been tailored for this population. Understanding risk factors and targets for intervention among PLWH are essential; cohort studies can provide the information needed for intervention development. This proposal is part the Consortia for HIV/AIDS and Alcohol-Related Research Trials (CHAART). It describes the continuation and expansion of a cohort that is one of three in the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH). The URBAN ARCH theme is to address consequences of alcohol use on HIV-associated comorbidities and complications to increase treatment availability and improve outcomes. In line with that theme we propose to continue to follow and expand (to 400) an existing cohort of PLWH and a high prevalence of exposure to alcohol, illicit drugs, and polypharmacy (the Boston ARCH Cohort) in the Frailty, Functional impairment, Falls, and Fractures (4F study) to: (in 2 Primary Aims) 1) Test the associations between alcohol (and illicit drugs and polypharmacy) and falls (fractures secondarily); and 2) Test the associations between alcohol (and illicit drugs and polypharmacy) and acute healthcare utilization (emergency department use and hospitalization for falls and fractures). We will also examine the role frailty plays in these associations between alcohol, drugs and medications and the aforementioned clinical and utilization outcomes. In Exploratory Aims we will test associations between alcohol use and inflammatory markers, and between markers and HIV-associated complication outcomes (4Fs); and develop and pilot test the feasibility of a falls prevention intervention tailored to address the identified risk factors (e.g. alcohol, illicit drugs, polypharmacy) in this population. By achieving these aims we will gain substantially greater understanding of these comorbidities and complications in PLWH exposed to alcohol and other psychoactive substances; this knowledge will serve to inform the development of ways to identify, prevent and manage falls, fractures, frailty and functional impairment.

每年有多达三分之一的艾滋病毒感染者 (PLWH) 中年人经历跌倒。瀑布是 在美国造成非致命伤害的最常见原因以及急诊科就诊和治疗的费用 住院人数是巨大的。 PLWH 更容易跌倒及其严重后果，因为 1) 尽管 HIV 病毒血症得到控制，但炎症仍然存在，并且是 HIV 相关合并症的基础 相对年轻时发生的并发症（所谓的过早衰老），2) 特定的合并症（例如， 神经病、骨质疏松症）和并发症（例如虚弱和身体机能受损）使跌倒更频繁 可能并且恢复更加困难，3）饮酒会加剧炎症，并可能增加风险 合并症和并发症，以及 4) 饮酒、非法药物使用和复方用药可能会增加 跌倒的可能性。尽管如此，跌倒预防尚未在感染者中得到广泛研究。我们需要 旨在解决艾滋病毒感染者数量下降问题的干预措施，但没有一项是针对这一人群量身定制的。了解风险 对感染者进行干预的因素和目标至关重要；队列研究可以提供信息 干预开发所需。 该提案是艾滋病毒/艾滋病和酒精相关研究试验联盟 (CHAART) 的一部分。它 描述了乌干达俄罗斯波士顿酒精公司三个队列之一的延续和扩展 艾滋病毒/艾滋病酒精研究合作网络 (URBAN ARCH)。 URBAN ARCH 的主题是 解决饮酒对艾滋病毒相关合并症和并发症的影响，以增加治疗 可用性并改善结果。根据该主题，我们建议继续遵循和扩展（以 400) 现有的感染者队列和酒精、非法药物和多种药物暴露的高流行率 （波士顿 ARCH 队列）在虚弱、功能障碍、跌倒和骨折（4F 研究）中：（在 2 个小学 目标）1）测试酒精（以及违禁药物和复方药物）与跌倒（骨折）之间的关联 其次）； 2) 测试酒精（以及非法药物和复方药物）与急性发作之间的关联 医疗保健利用（急诊科使用以及跌倒和骨折住院治疗）。我们还将 研究虚弱在酒精、毒品和药物之间的关联中所扮演的角色以及 上述临床和使用结果。在探索性目标中，我们将测试之间的关联 饮酒和炎症标志物，以及标志物和 HIV 相关并发症结果之间的关系 （4F）；制定并试点测试针对跌倒预防干预措施的可行性 确定了该人群的危险因素（例如酒精、非法药物、复方用药）。通过实现这些目标，我们 将更好地了解暴露于 PLWH 的这些合并症和并发症 酒精和其他精神活性物质；这些知识将有助于开发方法 识别、预防和处理跌倒、骨折、虚弱和功能障碍。