Mechanisms of Disparities in Adverse Neurocognitive Outcomes among Hispanics Aging with HIV

项目摘要 艾滋病毒和相关合并症对中枢神经系统的不良后果仍然普遍存在 尽管抗逆转录病毒治疗非常有效，但大约40%的艾滋病毒感染者仍表现出 神经认知障碍（NCI）。与美国其他种族相比，艾滋病毒感染者 (HIV+）西班牙裔/拉丁裔/as，以下简称为西班牙裔，NCI风险增加， 神经认知能力下降;这种风险在老年人中尤其明显。然而，这些背后的因素 差异没有得到很好的理解。国家少数民族健康和健康差异研究所（National Institute of Minority Health and Health Disparities） 研究框架，本建议旨在确定不利的关键机制 神经认知结果的研究在该组NCI的潜在预测因素中， 拟议的研究将集中在两个生物过程--代谢综合征和肠道微生物群失调 这在西班牙裔美国人中可能特别成问题，可能导致大脑更容易感染艾滋病毒。 该研究还将整合物理/建筑和社会文化环境的各个方面（通过 地理编码）与代谢综合征和NCI有关，并研究它们对 神经认知差异我们还将探讨行为（体力活动和饮食）的影响， 卫生保健（卫生保健的使用和获得，卫生知识）变量。我们将在200个艾滋病毒阳性的国家收集这些数据， 40岁及以上未感染艾滋病毒的西班牙裔（约一半讲西班牙语），并调查他们的 在三年的时间里，对神经认知状态的横向和纵向影响。我们将 利用UCSD HIV神经行为研究计划的现有纵向数据， 100名HIV+非西班牙裔白人的对照组。为确保拟议的多学科 方法，我们组建了一个代表相关学科整合的研究团队，包括 跨文化神经心理学，健康差异，医学，公共卫生，微生物，地理，和 生物信息学和信息系统。认识到以社区为基础的参与性 研究方法在研究健康差距时，我们与社区诊所合作， 他们的意见有助加强我们的工作方针，并确保我们的工作方针切合社会需要。我们 将在PI领导的西班牙裔现有横断面研究的基础上招募参与者， 拟议的研究，我们的社区伙伴关系将有助于确保我们达到最脆弱的群体 西班牙裔社区。通过这种多学科和社区综合的研究方法，我们的目标是 增加我们对神经认知差异机制的复杂性的理解， 结果之间的不同群体的西班牙裔老龄化与艾滋病毒。这些知识对于发展 有针对性的，文化相关的干预措施，以预防或改善西班牙裔人中与艾滋病毒相关的NCI， 减少健康差距。

PROJECT SUMMARY The adverse consequences of HIV and related comorbidities on the central nervous system remain prevalent despite highly effective antiretroviral therapy, with approximately 40% of persons living with HIV showing neurocognitive impairment (NCI). Compared to other ethnic/racial groups in the United States, HIV infected (HIV+) Hispanics/Latinos/as, hereafter referred to as Hispanics, present with increased risk for NCI and neurocognitive decline; and this risk is particularly pronounced in older age. Yet, the factors underlying these disparities are not well understood. Guided by the National Institute of Minority Health and Health Disparities Research Framework, the present proposal aims to identify key mechanisms underlying adverse neurocognitive outcomes among Hispanics aging with HIV. Among the potential predictors of NCI in this group, the proposed study will focus on two biological processes -- metabolic syndrome and gut microbiome dysbiosis -- that may be particularly problematic among Hispanics and may result in greater brain vulnerability to HIV. The study will also integrate aspects of the physical/built and sociocultural environment (assessed via geocoding) that have been linked to metabolic syndrome and NCI, and investigate their influence on neurocognitive disparities in HIV. We will also explore the impact of behavioral (physical activity and diet) and healthcare (healthcare use and access, health literacy) variables. We will collect these data in 200 HIV+ and HIV-uninfected Hispanics (approximately half Spanish-speaking) aged 40 and over, and investigate their impact on neurocognitive status cross-sectionally and longitudinally over the course of three years. We will leverage existing longitudinal data from the UCSD HIV Neurobehavioral Research Program to select a comparison group of 100 HIV+ non-Hispanic Whites. To ensure the success of the proposed multidisciplinary approach, we have assembled a research team representing an integration of relevant disciplines, including cross-cultural neuropsychology, health disparities, medicine, public health, microbiomics, geography, and bioinformatics, and information systems. Recognizing the importance of a community-based participatory research approach in the study of health disparities, we have partnered with community clinics and stakeholders whose input has helped strengthen our approach and assure its relevance to the community. We will build on existing cross-sectional studies in Hispanics led by the PI for recruitment of participants into the proposed study, and our community partnerships will help assure that we reach the most vulnerable segments of the Hispanic community. With this multidisciplinary and community integrated approach to research, we aim to increase our understanding of the complexity that underlies mechanisms of disparities in neurocognitive outcomes among diverse groups of Hispanics aging with HIV. Such knowledge is crucial for the development of targeted, culturally relevant interventions to prevent or ameliorate HIV-associated NCI among Hispanics and reduce health disparities.