Resilience, Norepinephrine, and Health Outcomes in Women with HIV

描述（由申请人提供）：随着高效抗逆转录病毒疗法（HAART）的出现和适当的坚持，艾滋病毒不再是死刑判决，可以被视为一种慢性病。重要的是探索可能促进艾滋病毒感染者延长寿命和改善健康结果的因素。在感染艾滋病毒的妇女和高危妇女中，创伤史的发生率很高，这与艾滋病毒药物不依从性和危险性行为有关。然而，有些女性在面对创伤时可能会恢复过来，在人际关系、自我意识和工作经历中获得适应性行为。文献集中在使妇女“处于”艾滋病毒传播/感染、不良健康结果和性危险行为的“风险”因素上，而对可能使妇女“有希望”获得更好结果的因素的关注要少得多。该建议通过关注创伤后恢复力的重要未被充分研究的因素以及它与生物应激激素（即去甲肾上腺素）和艾滋病毒感染妇女和艾滋病毒感染风险妇女的健康结果的关系，增加了文献。将对艾滋病毒阳性和高危妇女的健康结果进行评估，包括冠心病风险、抑郁、生活质量，而对艾滋病毒阳性妇女，具体指标将包括艾滋病毒疾病进展标志物和药物依从性。去甲肾上腺素（NE）是一种神经递质，在机体对压力的生物学和行为反应中起关键作用，并与HIV疾病进展标志物有显著关联。一般来说，较高的NE水平与更严重的疾病进展有关。然而，人们对NE水平与积极的社会心理因素（如恢复力）之间的关系知之甚少。在经历过创伤的感染艾滋病毒或有感染艾滋病毒风险的妇女中，拟议的研究将检查复原力与健康结果之间的关系，测试复原力是否也与NE水平有关，以及NE是否可以作为这些关系的中介。研究结果可以更好地为制定更有效的预防、干预战略和良好的健康结果、降低发病率和死亡率提供信息。

DESCRIPTION (provided by applicant): With the advent of highly active antiretroviral therapy (HAART) and proper adherence, HIV is no longer a death sentence and can be viewed as a chronic illness. It is important to explore the factors that may promote greater longevity and better health outcomes for persons infected with HIV. There is a high prevalence of trauma history among women with HIV and those at risk, which is associated with HIV medication nonadherence, and risky sexual behaviors. However, some women may be resilient in the face of trauma, attaining adaptive behaviors in their relationships, sense of self, and work experiences. The literature has focused on factors that place women "at risk" for HIV transmission/contraction, poor health outcomes, and sexually risky behavior, and far less attention has been given to factors that may place women "at promise" for better outcomes. This proposal adds to the literature by focusing on the important understudied factor of resilience subsequent to trauma and how it relates to biological stress hormones (i.e. norepinephrine) and health outcomes among women with HIV and those at risk for HIV. The health outcomes that will be assessed for both HIV+ and at risk women include coronary heart disease risk, depression, quality of life, and for HIV+ women, specific indicators will include HIV disease progression markers and medication adherence. Norepinephrine (NE) is a neurotransmitter that plays a key role in the body's biological and behavioral response to stress and has shown significant association with HIV disease progression markers. In general, higher NE levels are linked to worse disease progression. However, little is known about how NE levels relate to positive psychosocial factors such as resilience. Among women with and at risk for HIV who have experienced trauma, the proposed study will examine the relationships between resilience and health outcomes, testing whether resilience also relates to NE levels and whether NE may serve as a mediator of these relationships. The findings may better inform the development of more effective prevention, intervention strategies and good health outcomes, decreasing morbidity and mortality rates.