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

 描述（由申请人提供）：神经认知障碍（NCI）仍然是人类免疫缺陷病毒（HIV）感染的高度流行和衰弱，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，而且他们在艾滋病毒和老年人中患NCI的风险都很高。然而，老年艾滋病毒感染者中的NCI尚未得到检查。这个指导职业发展奖（K23）应用程序旨在发展申请人的技能，成为一个独立的和文化精通的临床科学家，调查风险因素的作用，为NCI的发展与艾滋病毒感染和老龄化相结合的西班牙裔美国人。该应用程序包含一个有针对性的研究项目，以检查NCI在老年艾滋病毒感染的西班牙裔（主要是墨西哥血统/血统）和关键因素驱动与艾滋病毒和老龄化相关的NCI种族差异。阐明可能导致NCI种族差异的心理社会和生物医学因素是制定有针对性的文化相关干预措施以改善或尽量减少NCI的基础步骤，从而减少该亚群的健康差异。在NCI的许多潜在预测因素中，我们关注一组潜在的可改变的健康行为，这些行为在西班牙裔美国人中特别成问题，即使用健康服务和与健康生活方式相关的个人实践（即，饮食，以及身体和认知活动）。我们的目的还在于研究一些可能介导这些健康行为与NCI之间关联的生物医学因素，包括HIV疾病负担和代谢综合征。认识到西班牙裔是一个异质群体，本提案的研究部分主要集中在墨西哥裔/血统的西班牙裔，他们是美国最大的西班牙裔亚组。为了支持研究提案和候选人的长期目标，全面的拟议培训计划建立在申请人的临床神经心理学背景上，以及认知老化和艾滋病毒神经心理学的临床研究，以获得关键的神经艾滋病知识（即神经艾滋病的差异，以及艾滋病毒和老龄化的交叉），临床研究技能，特别是跨文化研究的相关性（即生物统计学、生物伦理学和社区参与）以及领导和科学交流技能。多学科指导团队包括本提案所有方面的专业知识，包括神经艾滋病差异（主要导师：Robert希顿博士;共同导师：Mara Luisa Zuniga;顾问：Mariana Cherner;合作者：Mario de la Rosa博士）;老龄化与艾滋病毒的交叉（共同导师：Dilip Jeste博士）包括神经医学意义（顾问：罗纳德埃利斯博士）;跨文化心理测量学和生物统计学（希顿博士和顾问：丹·芒加斯博士和弗洛林·瓦伊达博士），生物伦理学（祖尼加博士）和社区参与（祖尼加博士）。本提案将主要利用加州圣地亚哥大学的基础设施，包括艾滋病毒神经行为研究计划、萨姆和罗斯·斯坦老龄问题研究所、全球公共卫生司以及临床和转化研究所。它还将利用加州戴维斯大学和佛罗里达国际大学的专业知识。优秀的辅导团队和强大的基础设施将为申请人成功完成培训目标提供关键支持。这一关键的培训和执行拟议的研究计划的新经验，沿着她过去的临床和研究经验以及她的西班牙裔背景将使她处于一个独特的位置，进行高度影响力的研究，将服务于美国人口的增长，服务不足和弱势群体的需求。

 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.