LSUHSC CARC RC 5: Social Environmental Stress and Alcohol Use in Persons Living with HIV/AIDS (PLWHA) Currently, empirical research that takes a life course and social determinants perspective on health among persons living with HIV/AIDS (PLWHA) is limited, and a better understanding of the mechanism linking early life adversity (ELA) and chronic psychosocial stress (CPS) is needed for improved treatment and prevention efforts. Accumulating evidence suggests an important role of biologically-mediated pathways through which stress exposure during early childhood and adulthood gets under the skin and results in gradients of health and clinical outcomes among PLWHA, and across socioeconomic and racial/ethnic lines. The overall objective of this project is to gain a deeper understanding of the mechanisms through which ELA and CPS lead to poor clinical outcomes and the unique role that alcohol consumption plays in this pathway. Our central hypothesis is that ELA events have set individuals on a biologic trajectory that is evidenced in adulthood and exacerbated by CPS, but that ELA plays a significant role in clinical outcomes through its impact on biologic stress and coping behaviors like heavy alcohol use. We expect to achieve our objective through three specific aims, enrolling a dynamic longitudinal cohort of adults (18+ years) living with HIV in an urban Southeastern U.S. city with high prevalence of new HIV cases and a disaster-prone, high stress environment: 1) to examine the differential impact of CPS and ELA on patterns of alcohol use and markers of biologic stress-allostatic load and telomere length-and the mediating role of alcohol use; 2) to examine the roles of CPS and ELA, biologic stress and alcohol consumption patterns on clinical endpoints-namely, CD4 and medication failure; and 3) to explore the moderating roles of sex, race, age, and SES in the relation between CPS and ELA on alcohol use patterns, biologic stress and clinical endpoints. As the cohort of HIV-infected men and women ages, it is essential to adapt comprehensive strategies and to consider sex-, race- and age-specific issues that contribute to premature aging and health outcomes. Achievement of aims will improve clinical translational by: 1) testing a mechanism through which ELA may lead to poor clinical and biologic outcomes so that we can begin to better understand, develop, and expand translational strategies, 2) examination of how these factors, and alcohol in particular, influence not only clinical endpoints but also biologic stress, and 3) evaluating these relations across sex, racial and SES groups. Results will inform disease management and prevention efforts and the science behind ELA, CPS, and alcohol's impact on physiologic stress in an HIV population.
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