Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH

摘要LSUHSC CARC研究组成部分1： PLWH人群中的社区和人际压力、酒精和慢性共病 老年艾滋病毒携带者(PLWH)是易患慢性病和老年病风险较高的人群 综合症(即代谢改变、糖尿病、心血管疾病、癌症、肾脏疾病和 骨质疏松)。在PLWH中，心理和生理压力水平也更高 与较差的免疫状态、随时间增加的病毒载量、较快的疾病进展和较高的 死亡率。PLWH的共病情况可能会因高风险饮酒而进一步恶化； 患酒精使用障碍(AUD)的风险要高出两到三倍。迫切需要一种更深层次的 理解社区和人际层面的社会决定因素在慢性病中所起的作用 PLWH的合并症。社区和社交空间是重要的语境，通过它可以 决定因素会影响健康和健康行为。然而，在当前的科学研究中，存在着一个根本性的差距 以证据为基础的知识，了解人们在这些背景下实际经历了什么，他们对护理的影响 PLWH，以及他们可能如何与其他次优护理的驱动因素相互作用，如高危酒精使用和临床 合并症。我们的初步数据表明，不同程度的压力暴露对饮酒有重要作用。 结果和共病。研究组成部分1(RC1)的目标是确定以下方面的影响 社区和人际压力对PLWH行为和慢性共病的影响及其独特作用 酒精的使用在通路中起作用。我们的中心假设是，暴露在社区的压力源中 人际关系水平将影响临床合并症，如心脏代谢和认知结果 通过对酒精使用的影响以及额外的行为和应对机制。我们的方法将 将个人层面的人口统计和临床数据与邻里数据结合起来， 来自PLWH和艾滋病毒成人的人际接触。我们将结合高级建模技术来 确定个人、人际和社区层面的可测量变量和潜在变量之间的关系 结构，纵向测试酒精消费对影响的中介作用。我们还将探索 深度、个体空间和时间地理瞬时评估(GMA)数据收集自该队列。 RC1的S建议将基础科学与行为科学和社会科学联系起来，以流行病学来确定 酒精在艾滋病毒相关合并症中的作用。我们的项目将提供关键数据，直接告知 多层次干预措施，以改善少数群体社区和社区的健康，并持续 艾滋病毒和相关的合并症的最大负担。

Abstract LSUHSC CARC Research Component 1: Community and Interpersonal Stress, Alcohol, and Chronic Comorbidities among PLWH Aging persons living with HIV (PLWH) are a vulnerable population at higher risk for chronic illnesses and geriatric syndromes (i.e., metabolic alterations, diabetes, cardiovascular disease, cancer, renal disease, and osteoporosis). Higher levels of both psychosocial and physiological stress among PLWH have also been associated with poorer immune status, increased viral load over time, faster disease progression, and higher rates of mortality. Comorbid conditions in PLWH can be further exacerbated by at-risk alcohol use; and PLWH are two to three times more at risk of alcohol use disorder (AUD). There is a critical need for a deeper understanding of the roles that social determinants at the community and interpersonal levels play in chronic comorbidities in PLWH. Neighborhoods and social spaces are important contexts through which social determinants act to shape health and health behavior. However, there is a fundamental gap in current scientific evidence-based knowledge about what people actually experience in these contexts, their impact on care for PLWH, and how they may interact with other drivers of sub-optimal care such as at-risk alcohol use and clinical comorbidities. Our preliminary data suggest a significant role of stress exposure at multiple levels on alcohol use outcomes and comorbidities. The objective of Research Component 1 (RC1) is to determine the impact of community and interpersonal stress on behavioral and chronic comorbidities among PLWH, and the unique role that alcohol use plays in the pathways. Our central hypothesis is that exposure to stressors at the community and interpersonal levels will impact clinical comorbidities, such as cardiometabolic and cognitive outcomes in PLWH, through impacts on alcohol use and additional behavioral and coping mechanisms. Our approach will involve the incorporation of individual level demographic and clinical data along with neighborhood data and interpersonal exposures from PLWH and HIV- adults. We will incorporate advance modeling techniques to determine the relation of individual, interpersonal, and community level measurable variables and latent constructs, testing longitudinally the mediation of the effects by alcohol consumption. We will also explore in depth individual space and time geographical momentary assessment (GMA) data collected from this cohort. RC1’s proposed research links basic science with behavioral and social sciences, to epidemiology to determine the role in alcohol in HIV-associated comorbidities. Our project will provide key data that will directly inform multilevel interventions to improve the health of minority communities and neighborhoods that continually sustain the biggest burden of HIV and associated comorbidities.