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330万围产期感染艾滋病毒（paHIV+）的儿童感染艾滋病毒。PaHIV+和hiv暴露但未感染（HEU）的青年都有不良认知和行为健康结果的风险。这些青年绝大多数生活在低收入和中等收入国家（LMIC），仅在亚洲就有20多万艾滋病毒感染者和数百万高浓血症青年。随着有效抗逆转录病毒治疗的增加，新病例的数量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的幸存青年的复杂需求，他们必须应对艾滋病毒这一慢性、高度污名化和传染性疾病。根据这一理论，我们将确定弹性的关键决定因素，将其定义为“青春期在面对不利环境时的认知、情感和行为功能能力”。我们的中心假设是，paHIV+青年相对于HEU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都存在。我们利用paHIV+和HEU儿童的可获得性，纳入美国国立卫生研究院资助的PREDICT研究，进行长达8年的临床、认知和神经影像学随访。PREDICT研究显示，3-15岁paHIV阳性人群的最佳神经发育结果低于HEU和hiv未暴露/未感染的同龄人。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都为执行功能服务。本研究将在修正的社会行为理论（情境、社会调节和动机/能力因素）的指导下，研究paHIV+和HEU青少年的高级认知、执行、情感和行为功能，并确定心理弹性的决定因素。该研究还将确定风险和恢复力的神经解剖学相关性，使用新技术来测量脑容量和完整性，特别是对前额皮质区域感兴趣。此外，为了在全球范围内了解这一人群的需求，该研究将通过将结果数据与来自两个国家的类似数据集进行比较，来检查跨文化背景下恢复力的决定因素

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.