Research Supplements to Promote Diversity in Health-Related Research

项目总结/摘要 自从抗逆转录病毒疗法问世以来，艾滋病毒感染者的预期寿命已大大缩短。 在美国稳步上升。PLWH现在更有可能发展出与年龄相关的共病 非传染性疾病（NCDs）的发病率高于同龄未感染艾滋病毒的人， 非传染性疾病和年龄相关疾病的死亡率是最重要的。多种非传染性疾病的年龄调整率更高 艾滋病毒阴性者的比例更高。此外，艾滋病毒携带者患病率较高， 和严重程度的口腔疾病，特别是有关牙周组织，虽然解释这些因素， 差异仍然不清楚。例如，艾滋病毒相关的免疫抑制或病毒血症是否是主要原因 对于这些差异？生活方式因素和获得牙科护理是重要的决定因素吗？是 PLWH中的微生物组特征是唯一的，它会随着时间的推移而改变吗？自1988年以来，艾滋病与 静脉注射经验（ALIVE）研究成功地跟踪了一个低收入，主要是非洲人 在美国，有注射毒品史（PWID）的艾滋病毒感染者和高危人群在一个 巴尔的摩的社区队列研究。三十多年来，ALIVE已将事件的风险因素 艾滋病毒和进展到艾滋病或死亡，描述了危险行为的模式，确定了最佳艾滋病毒的障碍 护理，并提供了重要的见解艾滋病毒的自然和治疗过程中PWID。近年来， ALIVE已经过渡到探索衰老对艾滋病毒的影响，重点是表型和器官特异性 非传染性疾病（NCD）（例如，肝脏、肺、心血管、骨骼、肾脏、神经认知和 代谢性非传染性疾病）。拟议的项目利用ALIVE平台，重点关注艾滋病毒的综合影响 和非传染性疾病对口腔健康的影响。的具体目标 拟议项目是：1）确定艾滋病毒状况在多大程度上影响口服避孕药的获得和使用， 2）确定艾滋病毒感染状况在多大程度上影响自我报告和临床口腔健康状况; 3)确定HIV状态在多大程度上影响牙周炎的进展;以及4）确定 艾滋病毒状态影响牙周炎相关的口腔微生物组签名的程度。前三个具体目标 包括界定共病非传染性疾病在多大程度上起影响调节作用的次级目标。具体目标4： 第一个子目标描述了艾滋病毒对口腔微生物组的影响程度，第二个子目标定义了艾滋病毒如何影响口腔微生物组。 口腔微生物组特征的纵向变化影响牙周炎的进展。为了实现这些目标， 我们建立在一年两次的ALIVE研究访问的基础上，包括访谈、临床检查和biospe cimen组件， 并辅之以病历审查和登记处联系。这些目标的关键影响是阐明 社会和个人层面的机制，确定可改变的风险因素，并产生新的见解， 在巴尔的摩和全国范围内对艾滋病毒携带者进行有效和有针对性的口腔健康干预。

Project Summary/Abstract Since the advent of antiretroviral therapy (ART), the life expectancy of persons living with HIV (PLWH) has steadily increased in the United States. PLWH are now more likely to develop co-morbid age-related noncommunicable diseases (NCDs) than are similarly-aged HIV-uninfected persons, and the morbidity and mortality of NCD and age-related conditions is paramount. The age-adjusted rates of multiple NCDs are higher among PLWH than among persons who are HIV negative. In addition, PLWH experience higher prevalence and severity of oral diseases, particularly related to the periodontium, although the factors that explain these disparities remain unclear. For example, is HIV-related immune suppression or viremia primarily responsible for these differences? Are lifestyle factors and access to dental care important determinants? Is the microbiome signature in PLWH unique and does it change over time? Since 1988, the AIDS Linked to the Intravenous Experience (ALIVE) study has successfully followed a lower-income, predominantly African American population of HIV-infected and at-risk persons with a history of injecting drugs (PWID) in a community-based cohort in Baltimore. Over three decades, ALIVE has characterized risk f actors of incident HIV and progression to AIDS or death, described patterns of risk behaviors, identified barriers to optimal HIV care, and provided important insights into the natural and treated course of HIV among PWID. In recent years, ALIVE has transitioned to exploring the impact of aging with HIV, focusing on phenotypes and organ -specific non-communicable diseases (NCD) (e.g., liver, lung, cardiovascular, bone, kidney, neurocognitive and metabolic NCDs). The proposed project leverages the ALIVE platf orm to focus on the combined effects of HIV and NCDs on oral health at the health care-seeking, clinical, and microbiological levels. The Specific Aims of the proposed project are to: 1) determine to what extent HIV status influences access to and utilizat ion of oral health care services; 2) determine to what extent HIV status affects self-reported and clinical oral health status; 3) determine to what extent HIV status influences the progression of periodontitis; and 4) determine to what extent HIV status impacts the periodontitis-associated oral microbiome signature. The first three specific aims include sub-aims that define the extent to which comorbid NCDs act as effect modifiers. For specific aim 4, one sub-aim describes the extent to which HIV influences the oral microbiome and a second sub-aim defines how longitudinal changes in the oral microbiome signature affect periodontitis progression. To achieve these aims, we build upon biannual ALIVE study visits with interview, clinical examination, and biospe cimen components, supplemented by medical record review and registry linkages. The key impact of these aims is to illuminate social and individual-level mechanisms, identify modifiable risk factors, and produce novel insights to inform efficient and targeted oral health interventions for PLWH in Baltimore and nationally.