Determinants of Resilience in Youth with HIV infection and Youth affected by HIV

描述（由申请人提供）：全世界有330万围产期HIV感染（paHIV+）儿童携带HIV。PaHIV+和HIV暴露但未感染（HEU）的青年都有出现不良认知和行为健康结果的风险。这些青年中的绝大多数生活在低收入和中等收入国家，仅在亚洲就有20多万艾滋病毒携带者和数百万高浓缩铀青年。随着有效抗逆转录病毒治疗的增加，新病例数和儿童死亡率都有所下降。但是，提供者现在面临的挑战是满足越来越多幸存青年的复杂需求，他们必须将艾滋病毒作为一种慢性、高度耻辱化和可传播的疾病来应对。在此基础上，我们将确定弹性的关键决定因素，定义为“青少年在面对不利环境时的认知，情感和行为功能的能力”。我们的中心假设是，艾滋病毒携带者阳性青年相对于其高浓缩铀同龄人的能力会受到损害，但在这两个群体中，能力的关键决定因素将存在。我们利用参加NIH资助的PREDICT研究的PAHIV+和HEU儿童的可用性，进行长达8年的临床，认知和神经影像学随访。PREDICT研究显示，与高浓缩铀和未接触/未感染艾滋病毒的同龄人相比，3 - 15岁的艾滋病毒携带者的神经发育结果不太理想。随着儿童进入青春期，监测执行功能的发展至关重要，包括决策，计划和自我调节，并了解额叶和其他大脑区域的发展，这些区域在整个生命中促进执行功能。这项拟议的工作将检查更高的认知，执行，情感和行为功能，并确定在经修改的社会行动理论（上下文，社会监管和动机/能力因素）的指导下，在艾滋病毒阳性和高浓缩铀青少年的韧性的决定因素。该研究还将确定神经解剖学与风险和弹性的相关性，使用新技术来测量大脑体积和完整性，特别是对前额叶皮层区域感兴趣。此外，为了了解全球这一群体的需求，研究将通过将所得数据与两个国家的类似数据集进行比较，研究不同文化背景下复原力的决定因素。 美国和一个南非的同伙。我们的长期目标是将关于复原力决定因素的知识转化为预防性干预措施，以促进全世界数百万艾滋病毒阳性和高浓缩铀青年的健康。

DESCRIPTION (provided by applicant): There are 3.3 million perinatally HIV-infected (paHIV+) children living with HIV worldwide. PaHIV+ and HIV-exposed but uninfected (HEU) youth are both at risk for adverse cognitive and behavioral health outcomes. The vast majority of these youth live in low- and middle-income countries (LMIC) with over 200,000 paHIV+ and millions of HEU youth in Asia alone. With increased availability of effective antiretroviral treatment, the number of new cases, as well as child mortality has both decreased. But, providers are now challenged to meet the complex needs of a growing number of surviving youth who must cope with HIV as a chronic, highly stigmatized, and transmittable illness. With this rationale, we will identify critical determinants for resilience, defined as "competence durin adolescence in cognitive, emotional and behavioral functioning in the face of adverse circumstances". Our central hypothesis is that paHIV+ youth will have compromised abilities relative to their HEU peers, but in both groups, critical determinants for competency will exist. We leverage the availability of paHIV+ and HEU children enrolled in the NIH-funded PREDICT study with up to 8 years of clinical, cognitive and neuroimaging follow-up. The PREDICT study showed less optimal neurodevelopment outcomes in paHIV+ ages 3-15 years compared to their HEU and HIV-unexposed/uninfected peers. As children progress through adolescence, it is critical to monitor the development of executive function, including decision making, planning, and self-regulation, and to understand the development of the frontal lobe and other brain areas that subserve executive function throughout life. This proposed work will examine higher cognition, executive, emotional and behavioral functioning, and identify the determinants of resilience in paHIV+ and HEU adolescents as guided by the modified social action theory (contextual, social regulation and motivation/capabilities factors). The study will also determine the neuroanatomical correlates for risk and resilience using novel techniques to measure brain volume and integrity with particular interest in the prefrontal cortex area. Moreover, in order to understand the needs of this population globally, the study will examine determinants of resilience across culturally settings by comparing the resulting data to similar data sets from two US and one South African cohorts. Our long-term goal is to translate knowledge on the determinants of resilience into preventive interventions that will promote health in millions of paHIV+ and HEU youth worldwide.