Aging adults living with HIV are more vulnerable to developing age-related multimorbidity, that in turn leads to poor health outcomes and decreased quality of life. In particular, alcohol misuse (A), chronic pain (P), and cognitive impairment (C) are highly prevalent among people living with HIV (PWH), and particularly relevant to aging adults in this population. Historically, these three conditions have been studied mostly in silos, with a dearth of research investigating the multimorbidity of all three, potentially compounding the detrimental effects of any pairs of the three, especially among PWH age ≥50.
This project seeks to (1) provide descriptive information about APC multimorbidity, (2) test the relationships between APC multimorbidity with HIV-related correlates, and (3) assess feasibility and acceptability of collecting daily diary data for studying the temporal associations of alcohol misuse, chronic pain, cognitive impairment, and HIV-related clinical constructs among PWH aged ≥50.
In Aim 1, Dr. Yeung and her team will determine the prevalence of ever receiving clinical diagnoses of alcohol use disorder (AUD), pain-related conditions, and neurocognitive disorders, as well as the prevalence of pairs of these clusters (e.g., pain and cognitive disorders), and of the complete APC multimorbidity (i.e., all 3 clusters together) using existing electronic medical records from the DC Cohort Study. They will then seek to identify unobserved/latent profiles of APC multimorbidity using self-reported continuous measures of alcohol use, pain, and cognitive impairment from the Patient Reported Outcomes study (PROs) at two time points (time 1 – data collected, time 2 – data collection ongoing). In Aim 2, they intend to test how HIV-related clinical characteristics (e.g., levels of medication adherence and immunovirological parameters) are associated with diagnoses of disorders from a single cluster, pairs of clusters, and the complete APC multimorbidity from using existing DC Cohort Study data. Further, they will examine whether latent profiles of APC multimorbidity observed at time 1 predict HIV-related outcomes (e.g., self-reported medication adherence) reported at time 2 from the PROs and linked to the DC Cohort Study database. Lastly, to accomplish Aim 3, they will pilot a daily diary study with 10 PWH age ≥50 from the DC Cohort Study, collecting data on participants’ adherence to the diary collection protocols, as well as their qualitative experiences participating in the pilot.
Through these efforts the proposed project seeks to increase knowledge about the health burden of APC multimorbidity among PWH age ≥50. Furthermore, the proposed project lays the groundwork for future R01 projects that propose a more comprehensive study of the mechanisms of APC multimorbidity among PWH age ≥50.
Project Summary provided by the investigator