Environmental Lead Exposure and Premature Aging among Adolescents Living with HIV in Haiti

项目摘要：这项补充的父母资助的目标是改善艾滋病毒相关的健康结果 海地的青少年(10-19岁)和青年(20-24岁)。一个主要的重点是研究培训，以 将青少年艾滋病服务从诊所推广到社区。有证据表明，提供 社区服务提高了可获得性、社会接受度、成本效益，并最终实现了大规模 冲击力。母项目建立在美国国立卫生研究院三十年研究期间在海地建立的基础上 和对海天d-Etude Du Sarcome et Des传染病机会主义者小组(GHESKIO)的培训支持和 威尔康奈尔医学(WCM)，以解决海地青少年艾滋病毒流行问题。 Elsie Jean博士是博士后研究员，在拟议的指导性研究培训项目中， 她将确定青少年和青少年中血铅水平升高的流行率。 海地成人艾滋病毒携带者(AYALH)。此外，她还将探讨血液病和脑溢血症状之间的联系。 过早衰老，包括肾功能障碍和血压升高。海地以惊人的高领先优势 我们在GHESKIO的研究表明，42%的AYALH患者血液水平升高 压力。我们假设铅暴露在青春期早期和关键的发育期 可能是过早衰老的驱动因素，而过早衰老只会在整个生命过程中恶化。让·威尔博士 还要探索环境铅暴露的来源，以便设计干预措施，以防止或 减少暴露。Jean博士的职业目标是进行研究，以改善 AYALH和预防可能破坏全球ART推广成功的慢性并存。她 目标是识别和消除可能加速或加剧衰老的环境暴露 在AYALH之间进行加工，以防止过早老化。 Jean博士将扩大她的培训，并在三个领域积累专业知识：1)环境流行病学，2) HIV感染人群的心血管疾病流行病学，以及3)混合方法研究。她将完成 她在奎斯奎亚大学攻读公共卫生硕士学位，并参加了3门短期强化课程。她还将参与定期的研究- 在GHESKIO-Weill Cornell Fogarty研究研讨会上的正在进行的介绍。 Jean博士的研究计划利用了海地的两个既定队列。在青少年的参与者中 HIV临床前心血管疾病队列，她将测量500名AYALH患者的BLL，并将其患病率与 海地心血管疾病队列中未感染艾滋病毒的青少年和年轻人。她将衡量两国之间的联系 合并收缩压(SBP)和舒张压(DBP)(MmHg)的BLLS升高(&gt； 120/80)和肾功能不全(尿白蛋白/肌酐比值(ACR)和GT；30 mg/g或肌酐清除量(EGFR) Ml/min/1.73m2(按CKD-Epi方程计算))。在病例对照研究中，她将进行深入访谈和 对20名BLL升高的AYALH和20名非接触来源的AYALH进行有针对性的调查。

Project Summary: The goal of this supplement’s parent grant is to improve HIV-related health outcomes of adolescents (10-19 years) and youth (20-24 years) in Haiti. A major emphasis is on research-training to extend adolescent HIV services from the clinic to the community. Evidence demonstrates that providing services in the community improves access, social acceptability, cost-effectiveness, and ultimately large-scale impact. The parent program builds on the foundation established in Haiti during three decades of NIH research and training support to Groupe Haitien d-Etude du Sarcome et des Infections Opportunistes (GHESKIO) and Weill Cornell Medicine (WCM) to address the adolescent HIV epidemic in Haiti. Dr. Elsie Jean is a post-doctoral research fellow and in the proposed mentored research training project, she will establish the prevalence of elevated blood lead levels (BLLs) among adolescents and young adults living with HIV (AYALH) in Haiti. Further, she will explore the association between BLL and signs of premature aging including kidney dysfunction and elevated blood pressure. Haiti has alarmingly high lead levels documented in adults, and our research at GHESKIO indicates 42% of AYALH have elevated blood pressure. We hypothesize lead exposure during the early and critical developmental period of adolescence could be a driver of premature aging which will only progress in severity across the life-course. Dr. Jean will also explore sources of environmental lead exposure in order to design interventions to prevent or mitigate exposure. Dr. Jean’s career goal is to conduct research to improve the long-term outcomes of AYALH and prevent chronic co-morbidities that may undermine the success of global ART scale-up. Her objective is to identify and eliminate environmental exposures that may accelerate or exacerbate the aging process among AYALH in order to prevent premature aging. Dr. Jean will expand her training and build expertise in three areas: 1) environmental epidemiology, 2) CVD epidemiology among HIV-infected populations, and 3) mixed methods research. She will complete her MPH at Quisqueya University and 3 intensive short-courses. She will also participate in regular research- in-progress presentations in the GHESKIO-Weill Cornell Fogarty Research Seminar. Dr. Jean’s research plan leverages two established cohorts in Haiti. Among participants in the Adolescent HIV Preclinical CVD Cohort, she will measure BLLs in 500 AYALH and compare the prevalence to a cohort of HIV-uninfected adolescents and young adults in the Haiti CVD Cohort. She will measure the association of elevated BLLs with elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) (mmHg) (> 120/80) and renal dysfunction (urine albumin to creatinine ratio (ACR) >30 mg/g or creatinine clearance (eGFR mL/min/1.73 m2 using CKD-Epi equation)). In a case-control study, she will conduct in-depth interviews and targeted surveys among 20 AYALH with elevated BLLs and 20 without to explore sources of exposure.