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

高达三分之一的中年艾滋病毒感染者(PLWH)每年都会出现下降。瀑布是 在美国，非致命性伤害的最常见原因以及急诊科就诊和 住院治疗的人数很多。PLWH更容易摔倒及其严重后果，因为1) 尽管艾滋病毒病毒血症得到了控制，但炎症仍然存在，并成为艾滋病毒相关合并症和 发生在相对年轻的年龄的并发症(所谓的早衰)，2)特殊的共病(例如 神经病、骨质疏松症)和并发症(如虚弱和身体功能受损)会导致更多的跌倒 3)饮酒可能会加剧炎症，并可能增加患病风险 对于合并症和并发症，以及4)酒精使用、非法药物使用和多药联用会增加 摔倒的可能性。尽管如此，预防跌倒在PLWH中还没有得到广泛的研究。我们需要 针对PLWH中跌倒的干预措施，但没有针对这一人群量身定做。了解风险 PLWH干预的因素和目标是必不可少的；队列研究可以提供信息 干预发展所需要的。 这项提议是艾滋病毒/艾滋病和酒精相关研究试验联盟(CHAART)的一部分。它 描述了一个队列的延续和扩大，该队列是乌干达、俄罗斯和波士顿酒精公司中的三个之一 关于艾滋病毒/艾滋病的酒精研究合作网络(城市ARCH)。城市的主旋律是 解决酒精使用对艾滋病毒相关合并症和并发症的影响，以增加治疗 可获得性和改善结果。根据这一主题，我们建议继续跟踪和扩大(以 400)PLWH的现有队列，以及接触酒精、非法药物和多药联用的高流行率 (波士顿拱形队列)在脆弱、功能障碍、跌倒和骨折(4F研究)中：(在2个初级研究中 AIMS)1)测试酒精(以及非法药物和多药联用)与跌倒(骨折)之间的关系 其次)；和2)测试酒精(与非法药物和多药联用)和急性 医疗保健利用(跌倒和骨折的急诊科使用和住院治疗)。我们还将 研究脆弱在酒精、药物和药物之间的联系中所起的作用 上述临床和使用结果。在探索性目标中，我们将测试 酒精使用和炎症标志物，以及标志物和HIV相关并发症结局之间的关系 (4FS)；以及开发和试点测试针对以下问题量身定做的预防跌倒干预措施的可行性 确定了这一人群中的风险因素(如酒精、非法药物、多药)。通过实现这些目标，我们 将大大加深对PLWH暴露于 酒精和其他精神活性物质；这一知识将有助于制定出 识别、预防和管理跌倒、骨折、虚弱和功能损伤。

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.