Risk Factors for Abnormal Spirometry Among HIV+ Individuals in Nairobi, Kenya

描述(由申请人提供)：在资源有限的情况下扩大获得抗逆转录病毒治疗(ART)的机会，导致许多艾滋病毒感染者(HIV+)的存活时间延长。因此，慢性病和与老龄化相关的残疾可能会增加，就像发达国家艾滋病毒+人群中的情况一样。这将如何影响肺部健康和在资源有限的情况下艾滋病毒+个人的慢性肺病(CLD)流行率仍在很大程度上尚不清楚。在发达国家，艾滋病毒感染性肺部并发症的发生率已大幅下降，在当前的抗逆转录病毒治疗时代，CLD已成为艾滋病毒+成人发病率和死亡率的越来越重要的决定因素。在资源有限的国家，能够获得抗逆转录病毒治疗的艾滋病毒+患者比例仍然较少，过去20年来肺部疾病发生类似转变的程度尚未得到充分探讨。已知的增加慢性阻塞性肺疾病风险的因素，如吸烟，在发展中国家可能不那么重要，而风险因素，包括垂直获得的艾滋病毒、室内生物燃料燃烧和在较低的CD4细胞计数下开始抗逆转录病毒治疗，可能发挥更突出的作用。 该项目将评估肺功能下降的风险因素，使用肺活量测定法，在肯尼亚内罗毕科普特希望传染病中心接受艾滋病毒相关医疗护理的10岁艾滋病毒携带者中检测慢性肺病。希望中心是2004年与华盛顿大学合作创建的。利用已建立的基础设施和现有的包含艾滋病毒疾病阶段和治疗细节的临床研究数据库，申请者将收集标准化的问卷和呼吸评估，包括肺活量测定和脉搏血氧仪，以实现该项目的具体目标，即：1)确定艾滋病毒感染者中肺活量异常的风险因素；2)确定自我报告的呼吸道症状标准化评估的敏感性、特异性和预测价值，以及呼吸频率和血氧饱和度，以确定肺活量异常的艾滋病毒感染者。为了完成这一项目，申请者将接受与研究设计、数据收集和分析以及在资源有限的情况下负责任地进行临床研究有关的高级流行病学和生物统计学方法的正式培训。这个项目的培训和完成将推动申请者朝着改善肺部的目标前进。 作为一名独立的临床调查员，在当地和全球环境中从事卫生工作，重点关注与艾滋病毒相关的肺部疾病。 这项研究将产生重大成果，将加强目前HIV+个体对CLD风险因素的了解，并确定未来研究可能针对的可改变的风险因素，以减少CLD及其相关的发病率和死亡率的负担。此外，还将识别有肺活量测定异常风险的个体的临床特征并加以利用。 以未来筛查为目标，并在资源有限的情况下改善这些人的待遇。

DESCRIPTION (provided by applicant): Expanding access to antiretroviral therapy (ART) in resource-limited settings has resulted in prolonged survival for many HIV-infected (HIV+) individuals. As a consequence, chronic illness and aging-related disability are likely to increase as they have in cohorts of HIV+ individuals in developed countries. How this will impact lung health and the prevalence of chronic lung disease (CLD) among HIV+ individuals in resource-limited settings remains largely unknown. In developed countries, the incidence of infectious pulmonary complications of HIV has declined dramatically and CLD has surfaced as an increasingly important determinant of morbidity and mortality among HIV+ adults in the current ART era. In resource-limited countries where still proportionately fewer HIV+ individuals have access to ART, the extent to which a similar shift in pulmonary disease has occurred over the last 20 years has not been fully explored. Factors known to increase risk of CLD such as smoking tobacco may be less important in the developing world, and risk factors including vertically-acquired HIV, indoor biofuel burning and initiation of ART at lower CD4 cell counts may play more prominent roles. This project will evaluate risk factors for decreased lung function, measured using spirometry, to detect CLD among HIV+ individuals ¿10 years old who receive HIV-related medical care at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. The Hope Center was created in partnership with the University of Washington in 2004. Leveraging this established infrastructure and existing clinical research database, containing details of HIV disease stage and treatment, the applicant will collect standardized questionnaires and respiratory evaluations, including spirometry and pulse oximetry to achieve this project's specific aims, which are: 1) to determine risk factors for abnormal spirometry among HIV+ individuals and 2) to determine sensitivity, specificity and predictive value of a standardized assessment of self-reported respiratory symptoms, along with respiratory rate and oxygen saturation to identify HIV+ individuals with abnormal spirometry. To complete this project, the applicant will obtain formal training in advanced epidemiologic and biostatistical methods related to study design, data collection and analysis, and the responsible conduct of clinical research in resource-limited settings. This training and completion of this project will propel the applicant toward her goal of improving lung health in local and global settings as an independent clinical investigator, with a focus on HIV-related lung disease. This study will yield significant results that will enhance current knowledge of CLD risk factors among HIV+ individuals and identify modifiable risk factors that may be targeted in future studies to decrease the burden of CLD and its associated morbidity and mortality. In addition, clinical features of individuals at risk for abnormal spirometry will be identified and can be used to target future screening and improve treatment of these individuals in resource-limited settings.