Assessing Syndemics of Cardiovascular Disease in People with and without HIV

项目摘要/摘要 联合抗逆转录病毒疗法(ART)已导致慢性病患者的发病率和死亡率显著下降 HIV(威尔斯亲王医院)。然而，随着PWH年龄的增长，心血管疾病(CVD)的风险增加，预计 威尔斯亲王一生的负担男性为65%，女性为44%。在威斯康星医院观察到的较高的心血管疾病风险 与一般人群相比，是由于既定心血管疾病危险因素患病率较高 (吸烟、酗酒、血脂异常)和艾滋病毒感染的直接影响，包括免疫缺陷和 发炎。最近的研究也表明整合酶链抑制剂和其他ART具有增加的 体重，这可能会进一步增加患心血管疾病的风险。还有许多未得到充分研究的社会和经济问题 可能导致威尔斯亲王医院心血管疾病风险较高的条件，包括在获得医疗保健和 治疗、社会隔离、精神创伤史和艾滋病毒污名。虽然大多数研究都考虑到了 在孤立的心血管疾病危险因素中，众所周知，许多因素经常同时发生，如吸烟、酗酒、 肥胖症和抑郁症。此外，社会因素加剧生物医学心血管疾病影响的方式 威尔斯亲王的危险因素还不是很清楚。使用Syndemics框架，该框架唯一适合于 评估弱势群体的社会和生物条件的聚集性，我们将调查 威尔斯亲王医院心血管疾病风险持续高企的原因。凭借该团队在艾滋病毒方面的跨学科专业知识， 我们的研究旨在了解社会、经济和生物因素是如何结合在一起的 在威尔斯亲王医院，导致他们患心血管疾病的风险很高。我们将利用全面的电子健康记录(EHR) 来自Kaiser Permanente(KP)的数据和来自KP Research Bank的详细现有调查和生物谱 (九龙公共关系科)。在目标1中，我们将检验与主要不良心血管事件(MACE)的协同关系 在2000-2021年在KP登记的29,000名PWH和1：20匹配的未感染艾滋病毒(PWoH)的人中。我们会 评估EHR中可用的社会和生物因素，如精神健康、物质使用 精神障碍(SUD)、邻里剥夺和保险福利。对于目标2，我们将执行一项 KPRB内的补充研究，以确定1,969人与亚临床心血管疾病的协同关系 PWH(709与生物菌种)和1：1匹配的pWoH。我们会从调查中考虑其他社会因素。 这可能会影响心血管疾病风险，包括歧视和耻辱、社会孤立、情感和实际健康。 支持，以及经济因素。最后，目标3将涉及从高风险群组招聘60名威尔斯亲王医院 在目标1和目标2中确定，进行深入的定性访谈，以探索共性条件是如何起作用的 有很高的心血管疾病风险。访问将成为对350名从同一所高中招聘的威尔斯亲王医院的后续调查的依据。 风险集群，以确认未来心血管疾病中可能解决的更大样本中的共同情况 预防工作。结合定量和定性的数据源，这项研究有很大的潜力提供信息 未来社区和卫生系统层面的综合干预措施，以减轻威尔斯亲王医院的心血管疾病负担。

PROJECT SUMMARY/ABSTRACT Combination antiretroviral therapy (ART) has led to dramatic declines in morbidity and mortality for people with HIV (PWH). However, as PWH age, the risk of cardiovascular disease (CVD) has increased, with a projected lifetime burden among PWH of 65% for men and 44% for women. The higher observed risk of CVD in PWH compared with the general population is a result of the higher prevalence of established CVD risk factors (smoking, alcohol, dyslipidemia), and direct effects of HIV infection, including immunodeficiency and inflammation. Recent studies have also implicated integrase strand inhibitors and other ART with increases in body weight, which may further increase risk of CVD. There are also many understudied social and economic conditions that may contribute to the high CVD risk in PWH, including disparities in healthcare access and treatment, social isolation, history of trauma, and HIV stigma. While most studies have considered the impact of CVD risk factors in isolation, it is well known that many frequently co-occur, such as smoking, alcohol, obesity and depression. Furthermore, the ways in which social factors exacerbate the effect of biomedical CVD risk factors among PWH is not well understood. Using a syndemics framework, which is uniquely suited for the evaluation of the clustering of social and biological conditions in vulnerable populations, we will investigate reasons for the persistently high risk of CVD among PWH. With the team’s interdisciplinary expertise in HIV, CVD and syndemics, our study is designed to understand how social, economic and biological factors combine in PWH, contributing to their high CVD risk. We will leverage comprehensive electronic health record (EHR) data from Kaiser Permanente (KP) and detailed existing survey and biospecimen from the KP Research Bank (KPRB). In Aim 1, we will examine synergistic relationships with major adverse cardiovascular events (MACE) among 29,000 PWH and 1:20 matched people without HIV (PWoH) enrolled in KP from 2000-2021. We will evaluate clusters of social and biological factors available in EHRs such as mental health, substance use disorders (SUD), neighborhood deprivation, and insurance benefits. For Aim 2, we will perform a complementary study within the KPRB to identify synergistic relationships with subclinical CVD among 1,969 PWH (709 with biospecimens) and 1:1 matched PWoH. We will consider additional social factors from surveys that may impact CVD risk, including discrimination and stigma, social isolation, emotional and practical health support, and economic factors. Finally, Aim 3 will involve recruitment of 60 PWH from high-risk clusters identified in Aims 1 and 2 for in-depth qualitative interviews to explore how the syndemic conditions contribute to the high CVD risk. The interviews will inform a follow-up survey of 350 PWH recruited from the same high- risk clusters, to confirm syndemic conditions in a larger sample that could be addressed in future CVD prevention efforts. Integrating quantitative and qualitative data sources, this study has great potential to inform future comprehensive community- and health system-level interventions to reduce the CVD burden in PWH.