Pathways to successful aging among perinatally HIV-infected and exposed young adults: Risk, resilience, and the role of perinatal HIV infection

艾滋病毒治疗和预防的进步导致数百万名围产期艾滋病毒感染者(PHIV)和围产期 感染艾滋病毒但未感染(PHEU)的儿童存活到青春期和成年期。青壮年 可能是一个不稳定的发育期，艾滋病毒青壮年(YA)患精神疾病的风险特别高 健康问题，危险行为，以及由于妥协的“完美风暴”而难以达到成人里程碑的问题 健康、生活压力源和神经认知缺陷。艾滋病毒控制不力加剧了这些风险， PHIV和Pheu YA遇到的心理社会应激源，导致慢性炎症反应， 损害精神功能、神经认知和整体健康结果。在过去的15年里，CASAH 跟踪调查了340名居住在纽约脆弱社区的艾滋病毒和菲U青年(9-16岁注册) 城市，记录了童年、青春期和成年初期的风险和韧性。这场竞争 CASAH(R01-MH69133-15)的延续，CASAH4，将跟随这个队列直到年轻成年(20多岁-早期 30s)，产生了关于心理健康、健康危险行为、 以及在PHIV和Pheu YA中成人里程碑的成就。在社会行动理论(SAT)指导下， CASAH4提供了一个独特的机会，可以利用我们独特的纵向数据集来了解两者的影响 终生感染艾滋病毒，以及心理健康的背景、社会调节和自我调节决定因素， 健康危险行为和成人里程碑成就。在CASAH4中，我们的目标是1)检查艾滋病毒的影响 感染对行为健康结果的影响(如精神健康、性风险、药物使用、依从性)和 实现成人里程碑(例如，教育、职业、独立)；2)检查SAT如何了解风险 以及保护性因素对YA行为健康和成人里程碑成就的影响；3)探索轨迹 青春期和青春期的行为健康和SAT对这些轨迹的预测； 以及4)比较全球三个地区青年的行为健康结果及其SAT信息预测因子 按青春期早期(9-12岁)、中期(13-15岁)和晚期(16-19岁)艾滋病毒状况分类。建房 在我们以前的工作基础上，我们将加强对成人里程碑、精神功能和 神经认知功能，并将增加生物医学健康指标(炎症和免疫激活 与精神障碍和神经认知功能相关的生物标记物)与HIV RNA病毒载量和 已经收集了CD4+细胞计数。CASAH在风险和复原力研究方面做出了重大贡献 在PHIV和Pheu青年中发表了117份出版物和65份科学报告，并直接向精神- 美国和国外的健康和艾滋病毒预防干预和服务体系。具有多学科和 跨文化团队，我们有一个独特的机会将我们的工作延伸到青少年时期，以确定 行为风险轨迹和青少年功能的可修改预测因子，并为发展提供信息 及时、有针对性和基于证据的干预措施，在全球范围内对易受感染的艾滋病毒和PHEU进行干预。

Advances in HIV treatment and prevention have led to millions of perinatally HIV-infected (PHIV) and perinatally HIV-exposed, but uninfected (PHEU) children surviving into adolescence and young adulthood. Young adulthood can be a precarious developmental period, and PHIV young adults (YA) are at particularly high risk for mental health problems, risk behaviors, and difficulties achieving adult milestones due to a “perfect storm” of compromised health, life stressors, and neurocognitive deficits. These risks are exacerbated by inadequately controlled HIV, and psychosocial stressors encountered by both PHIV and PHEU YA, leading to chronic inflammatory responses that compromise psychiatric function, neurocognition, and overall health outcomes. For the past 15 years, CASAH has followed 340 PHIV and PHEU youth (enrolled at ages 9-16 years) living in vulnerable communities in New York City, documenting risk and resilience across childhood, adolescence, and emerging adulthood. This competing continuation of CASAH (R01-MH69133-15), CASAH4, will follow this cohort through young adulthood (20s-early 30s), leading to one of the most comprehensive longitudinal data sets on mental health, health risk behavior, and achievement of adult milestones among PHIV and PHEU YA. Guided by Social Action Theory (SAT), CASAH4 offers a unique opportunity leverage our unique longitudinal data set to understand the impact of both lifelong HIV infection and also contextual, social-regulation, and self-regulation determinants of mental health, health risk behaviors, and adult milestone achievement. In CASAH4 we aim to 1) examine the impact of HIV infection on behavioral health outcomes (e.g., mental health, sexual risk, substance use, adherence) and achievement of adult milestones (e.g., education, vocation, independence); 2) examine how SAT-informed risk and protective factors affect YA behavioral health and achievement of adult milestones; 3) explore trajectories of behavioral health across adolescence and young adulthood and SAT-informed predictors of these trajectories; and 4) compare behavioral health outcomes and their SAT-informed predictors among youth across three global cohorts by PHIV-status at early (9-12 years), middle (13-15 years), and late (16-19 years) adolescence. Building on our previous work, we will enhance our assessment of adult milestones, psychiatric function, and neurocognitive function, and will add biomedical health indicators (inflammation and immune activation biomarkers associated with psychiatric disorders and neurocognitive function) to the HIV RNA viral load and CD4+ cell count already collected. CASAH has made significant contributions to research on risk and resilience in PHIV and PHEU youth with 117 publications and 65 scientific presentations, and has directly informed mental- health and HIV-prevention interventions and service systems in the US and abroad. With a multidisciplinary and cross-cultural team, we have a unique opportunity to extended our work into young adulthood, to identify modifiable predictors of behavioral risk trajectories and young adult function, and to inform the development of timely, targeted, and evidence-based interventions for vulnerable PHIV and PHEU across global contexts.