Neurocognitive impairment (NCI) continues to be highly prevalent and debilitating in human immunodeficiency virus (HIV) infection, particularly among older persons. Hispanics are the fastest growing segment of the older adult population in the U.S., they are disproportionately represented among cases of HIV infection, and they are at elevated risk for NCI in both HIV and older age, separately. Yet, NCI among older HIV-infected Hispanics has not been examined. This Mentored Career Development Award (K23) application is designed to develop the applicant's skills to become an independent and culturally proficient clinical scientist investigating the role of risk factors for the development of NCI associated wit combined HIV infection and aging among Hispanics. The application contains a targeted research project to examine NCI in older HIV-infected Hispanics (primarily of Mexican origin/descent) and key factors driving ethnic differences in NCI associated with HIV and aging. Elucidation of psychosocial and biomedical factors that might lead to ethnic differences in NCI is a foundational step in developing targeted, culturally-relevant interventions to improve or minimize NCI, and thus reduce health disparities in this subpopulation. Among the many potential predictors of NCI, we focus on a set of potentially modifiable health behaviors that are particularly problematic among Hispanics, namely use of health services and personal practices associated with a healthy lifestyle (i.e., diet, and physical and cognitive activity). We also aim o examine some of the biomedical factors that might mediate the association of these health behaviors with NCI, including HIV disease burden and metabolic syndrome. Recognizing that Hispanics are a heterogeneous group, the research component of the present proposal focuses primarily on Hispanics of Mexican origin/descent, who are the largest Hispanic subgroup in the U.S. In support of the research proposal and the candidate's long-term goals, the comprehensive proposed training program builds on the applicant's background in clinical neuropsychology, as well as clinical research on cognitive aging and the neuropsychology of HIV, to gain key neuroAIDS knowledge (i.e. neuroAIDS disparities, and the intersection of HIV and aging), clinical research skills of particular relevance for cross-cultural studies (i.e. biostatistics, bioethics, and community engagement), as well as leadership and scientific communication skills. The multidisciplinary mentoring team includes expertise in all aspects of this proposal including neuroAIDS disparities (Primary Mentor: Dr. Robert Heaton; Co-mentor: Mara Luisa Zuniga; Consultant: Mariana Cherner; Collaborator: Dr. Mario de la Rosa); the intersection of aging and HIV (Co-Mentor: Dr. Dilip Jeste) including neuromedical implications (Consultant: Dr. Ronald Ellis); and cross-cultural psychometrics and biostatistics (Dr. Heaton and Consultants: Drs. Dan Mungas and Florin Vaida), bioethics (Dr. Zuniga), and community engagement (Dr. Zuniga). The present proposal will capitalize primarily on the University of California San Diego infrastructure, including the HIV Neurobehavioral Research Program, the Sam and Rose Stein Institute for Research on Aging, the Division of Global Public Health, and the Clinical and Translational Research Institute. It will also leverage expertise at the Universit of California Davis, and Florida International University. The excellent mentoring team and robust infrastructure will provide critical support to the applicant to successfully complete her training goals. This key training and new experience in executing the proposed research plan, along with her past clinical and research experiences and her Hispanic background will place her in a unique position to conduct highly impactful research that will serve the needs of a growing, underserved and vulnerable segment of the U.S. population.

Public Health Relevance

The proposed Mentored Patient-Oriented Research Career Development Award (K23) aims to investigate differences between Hispanics and non-Hispanic Whites in neurocognitive impairment (i.e., problems with attention, learning and memory, and other cognitive skills) associated with HIV and aging. This is an important public health priority because 1) neurocognitive problems in HIV are debilitating and especially prevalent as the number of HIV-infected persons reaching older age grows; and 2) Hispanics have higher rates of HIV-infection and worse HIV disease than non-Hispanic Whites, are the fastest growing ethnic group among older adults in the U.S., and have higher risk for neurocognitive problems both in HIV and in older age. Knowledge of the psychosocial and biomedical factors related to Hispanic ethnicity that increase risk for neurocognitive impairment associated with HIV and aging can help develop targeted, culturally relevant interventions to prevent and/or decrease neurocognitive impairment in this group and reduce health disparities.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23MH105297-02
Application #
8996718
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Brouwers, Pim
Project Start
2015-01-21
Project End
2018-12-31
Budget Start
2016-01-01
Budget End
2016-12-31
Support Year
2
Fiscal Year
2016
Total Cost
$170,657
Indirect Cost
$12,641
Name
University of California San Diego
Department
Psychiatry
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Moore, Raeanne C; Hussain, Mariam A; Watson, Caitlin W-M et al. (2018) Grit and Ambition are Associated with Better Neurocognitive and Everyday Functioning Among Adults Living with HIV. AIDS Behav 22:3214-3225
Marquine, María J; Flores, Ilse; Kamat, Rujvi et al. (2018) A composite of multisystem injury and neurocognitive impairment in HIV infection: association with everyday functioning. J Neurovirol 24:549-556
Dufour, Catherine A; Marquine, María J; Fazeli, Pariya L et al. (2018) A Longitudinal Analysis of the Impact of Physical Activity on Neurocognitive Functioning Among HIV-Infected Adults. AIDS Behav 22:1562-1572
Marquine, María J; Heaton, Anne; Johnson, Neco et al. (2018) Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States. J Int Neuropsychol Soc 24:163-175
Fields, Jerel Adam; Spencer, Brian; Swinton, Mary et al. (2018) Alterations in brain TREM2 and Amyloid-? levels are associated with neurocognitive impairment in HIV-infected persons on antiretroviral therapy. J Neurochem 147:784-802
Stoff, David M; Goodkin, Karl; Jeste, Dilip et al. (2017) Redefining Aging in HIV Infection Using Phenotypes. Curr HIV/AIDS Rep 14:184-199
Johnson, Neco X; Marquine, Maria J; Flores, Ilse et al. (2017) Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 23:640-652
Flores, Ilse; Casaletto, Kaitlin B; Marquine, Maria J et al. (2017) Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds. Clin Neuropsychol 31:783-797
Moore, Raeanne C; Marquine, María J; Straus, Elizabeth et al. (2017) Predictors and Barriers to Mental Health Treatment Utilization Among Older Veterans Living With HIV. Prim Care Companion CNS Disord 19:
Marquine, María J; Montoya, Jessica L; Umlauf, Anya et al. (2016) The Veterans Aging Cohort Study (VACS) Index and Neurocognitive Change: A Longitudinal Study. Clin Infect Dis 63:694-702

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