Project 3 - Impairment and multimorbidity among people aging with HIV and ART in South Africa

项目3：南非艾滋病毒和抗逆转录病毒治疗老年人的损害和多发病-- 摘要 抗逆转录病毒疗法(ART)的益处和副作用正在从根本上改变年龄 南非艾滋病毒携带者(PLHIV)的构成和多病 全球艾滋病病毒感染者和接受抗逆转录病毒治疗的人数。老龄化的PLHIV可能会患上大量的 认知障碍和痴呆症、身体障碍和多发病。这些损伤和 由于长期的影响，这种疾病很可能不同于那些没有感染艾滋病毒的人所遭受的痛苦。 HIV感染；长期抗逆转录病毒疗法的副作用；以及心理社会、行为和结构 PLHIV的特点。南非健康、老龄化与痴呆症项目3的研究 纵向研究(HAALSI)提案将填补对健康、老龄化和社会至关重要的知识空白 南非的政策：认知障碍的人口水平频率、类型和驱动因素 南方HIV高流行社区中PLHIV的痴呆、身体损害和多发病 和南部非洲。为此，我们将在以前的HAALSI艾滋病毒更新项目的基础上，并成功地 MRC/WITS农村公共卫生和健康过渡研究股(阿金库尔)和 哈佛人口与发展研究中心。首先，我们将量化全国范围内的流行性感冒流行情况 使用既定认知功能的南非艾滋病毒护理连续体中的认知和身体损害 HAALSI国家调查中的电池和身体功能测试。我们还将量化这些变化 跨年龄段的认知和身体损害以及使用纵向 哈尔西·阿金库尔军团。其次，我们将确定老年人的独特多发病特征。 南非的艾滋病毒和抗逆转录病毒疗法，使用生物标记物、人体测量学和认知和 关于一系列疾病和状况的心理数据，包括艾滋病毒、高血压、糖尿病、肥胖、 高胆固醇血症、高甘油三酯血症、抑郁症、认知障碍和痴呆。第三，我们 将利用准实验方法来确定艾滋病毒和抗逆转录病毒疗法的长期影响，以及 老年PLHIV对认知障碍的心理社会、行为和结构特征包括 南非的痴呆症、身体损伤和慢性多发病。我们的研究将为我们提供 设计确保健康和有尊严的老龄化的政策和计划所急需的证据 在南非和更广泛的南部地区大量且不断增长的老年艾滋病毒携带者中 非洲地区。

Project 3: Impairment and multimorbidity among people aging with HIV and ART in South Africa – Abstract The benefits and side effects of antiretroviral therapy (ART) are fundamentally changing the age composition and multimorbidities of people living with HIV (PLHIV) in South Africa, which has the largest number of both PLHIV and people receiving ART globally. Aging PLHIV are likely to suffer from substantial cognitive impairment and dementia, physical impairment, and multimorbidities. These impairments and morbidities are likely distinct from those that people without HIV suffer from – because of the long-term effects of HIV infection; the side effects of long-term ART; and the psychosocial, behavioral, and structural characteristics of PLHIV. The research in Project 3 of the Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI) proposal will fill a knowledge gap that is critical for health, aging, and social policy in South Africa: the population-level frequencies, types, and drivers of cognitive impairment and dementia, physical impairment, and multimorbidity among PLHIV in HIV hyperendemic communities in South and Southern Africa. To do this, we will build on the previous HAALSI HIV renewal project, and the successful partnership between the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and the Harvard Center for Population and Development Studies. First, we will quantify the national prevalence of cognitive and physical impairment across the HIV care continuum in South Africa using established cognitive batteries and physical function tests in the HAALSI National survey. We will also quantify the changes in cognitive and physical impairment across the age course and the HIV care continuum using the longitudinal the HAALSI Agincourt cohort. Second, we will identify the distinct multimorbidity profiles of people aging with HIV and ART in South Africa, using clustering analyses of biomarker, anthropometric, and cognitive and psychological data on a range of diseases and conditions, including HIV, hypertension, diabetes, obesity, hypercholesterolemia and hypertriglyceridemia, depression, and cognitive impairment and dementia. Third, we will utilize quasi-experimental methods to establish the long-term effects of HIV and ART as well as the psychosocial, behavioral, and structural characteristics of older PLHIV on cognitive impairment including dementia; physical impairment; and chronic multimorbidity in South Africa. Our research will provide the evidence that is critically needed to design policies and programs that will ensure healthy and dignified aging among the large and growing population of older adults with HIV in South Africa and the broader Southern African region.