Risk and mechanisms of neurocognitive impairment in older HIV-infected Hispanics

 描述(申请人提供)：神经认知障碍(NCI)在人类免疫缺陷病毒(HIV)感染中仍然非常普遍，并使人虚弱，特别是在老年人中。拉美裔是美国老年人口中增长最快的部分，他们在艾滋病毒感染病例中所占比例不成比例，他们在艾滋病毒和老年人群中患NCI的风险都很高。然而，老年感染艾滋病毒的拉美裔美国人中的NCI还没有得到检查。这项指导职业发展奖(K23)的申请旨在培养申请者的技能，使其成为一名独立的、精通文化的临床科学家，研究风险因素在NCI相关疾病发展中的作用，并结合拉美裔人的艾滋病毒感染和老龄化。该应用程序包含一个有针对性的研究项目，以检查感染艾滋病毒的拉美裔老年人(主要是墨西哥血统/后裔)的非传染性疾病，以及导致与艾滋病毒和老龄化有关的非传染性疾病的种族差异的关键因素。阐明可能导致NCI的种族差异的心理社会和生物医学因素是制定有针对性的、与文化相关的干预措施的基础步骤，以改善或减少NCI，从而减少这一亚群中的健康差距。在许多NCI的潜在预测因素中，我们专注于一组潜在的可改变的健康行为，这些行为在拉美裔中特别有问题，即使用健康服务和与健康生活方式(即饮食、体力和认知活动)相关的个人实践。我们还旨在研究一些生物医学因素，这些因素可能会调节这些健康行为与NCI的关联，包括艾滋病毒疾病负担和代谢综合征。认识到拉美裔是一个不同的群体，本提案的研究部分主要侧重于墨西哥裔/裔拉美裔，他们是美国最大的拉美裔亚群。为了支持研究提案和候选人的长期目标，拟议的综合培训方案建立在申请人的临床神经心理学背景以及关于认知老化和艾滋病毒神经心理学的临床研究的基础上，以获得关键的神经艾滋病知识(即神经艾滋病差异，以及艾滋病毒和老龄化的交叉)、与跨文化研究特别相关的临床研究技能(即生物统计学、生物伦理学和社区参与)，以及领导力和科学沟通能力。多学科辅导团队包括本提案各个方面的专业知识，包括神经艾滋病差异(主要导师：Robert Heaton博士；联合导师：Mara Luisa Zuniga；顾问：Mariana Cherner；合作者：Mario de la Rosa)；老龄化与艾滋病毒的交集(共同导师：Dilip Just博士)，包括神经医学影响(顾问：Ronald Ellis博士)；跨文化心理测量学和生物统计学(Heaton博士和顾问：Dan Mungas博士和Florin Vaida博士)、生物伦理学(Zuniga博士)以及社区参与(Zuniga博士)。目前的提案将主要利用加州大学圣地亚哥分校的基础设施，包括艾滋病毒神经行为研究计划、山姆和罗斯·斯坦老龄化研究所、全球公共卫生司以及临床和翻译研究所。它还将利用加州大学戴维斯分校和佛罗里达国际大学的专业知识。优秀的指导团队和强大的基础设施将为申请者成功完成培训目标提供关键支持。这一关键培训和执行拟议研究计划的新经验，加上她过去的临床和研究经验以及她的拉美裔背景，将使她处于独特的地位，能够进行具有高度影响力的研究，满足日益增长的、服务不足的和脆弱的美国人口部分的需求。

 DESCRIPTION (provided by applicant): Neurocognitive impairment (NCI) continues to be highly prevalent and debilitating in human immunodeficiency virus (HIV) infection, particularly among older persons. Hispanics are the fastest growing segment of the older adult population in the U.S., they are disproportionately represented among cases of HIV infection, and they are at elevated risk for NCI in both HIV and older age, separately. Yet, NCI among older HIV-infected Hispanics has not been examined. This Mentored Career Development Award (K23) application is designed to develop the applicant's skills to become an independent and culturally proficient clinical scientist investigating the role of risk factors for the development of NCI associated wit combined HIV infection and aging among Hispanics. The application contains a targeted research project to examine NCI in older HIV-infected Hispanics (primarily of Mexican origin/descent) and key factors driving ethnic differences in NCI associated with HIV and aging. Elucidation of psychosocial and biomedical factors that might lead to ethnic differences in NCI is a foundational step in developing targeted, culturally-relevant interventions to improve or minimize NCI, and thus reduce health disparities in this subpopulation. Among the many potential predictors of NCI, we focus on a set of potentially modifiable health behaviors that are particularly problematic among Hispanics, namely use of health services and personal practices associated with a healthy lifestyle (i.e., diet, and physical and cognitive activity). We also aim o examine some of the biomedical factors that might mediate the association of these health behaviors with NCI, including HIV disease burden and metabolic syndrome. Recognizing that Hispanics are a heterogeneous group, the research component of the present proposal focuses primarily on Hispanics of Mexican origin/descent, who are the largest Hispanic subgroup in the U.S. In support of the research proposal and the candidate's long-term goals, the comprehensive proposed training program builds on the applicant's background in clinical neuropsychology, as well as clinical research on cognitive aging and the neuropsychology of HIV, to gain key neuroAIDS knowledge (i.e. neuroAIDS disparities, and the intersection of HIV and aging), clinical research skills of particular relevance for cross-cultural studies (i.e. biostatistics, bioethics, and community engagement), as well as leadership and scientific communication skills. The multidisciplinary mentoring team includes expertise in all aspects of this proposal including neuroAIDS disparities (Primary Mentor: Dr. Robert Heaton; Co-mentor: Mara Luisa Zuniga; Consultant: Mariana Cherner; Collaborator: Dr. Mario de la Rosa); the intersection of aging and HIV (Co-Mentor: Dr. Dilip Jeste) including neuromedical implications (Consultant: Dr. Ronald Ellis); and cross-cultural psychometrics and biostatistics (Dr. Heaton and Consultants: Drs. Dan Mungas and Florin Vaida), bioethics (Dr. Zuniga), and community engagement (Dr. Zuniga). The present proposal will capitalize primarily on the University of California San Diego infrastructure, including the HIV Neurobehavioral Research Program, the Sam and Rose Stein Institute for Research on Aging, the Division of Global Public Health, and the Clinical and Translational Research Institute. It will also leverage expertise at the Universit of California Davis, and Florida International University. The excellent mentoring team and robust infrastructure will provide critical support to the applicant to successfully complete her training goals. This key training and new experience in executing the proposed research plan, along with her past clinical and research experiences and her Hispanic background will place her in a unique position to conduct highly impactful research that will serve the needs of a growing, underserved and vulnerable segment of the U.S. population.