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Principal Investigator: MONICA G. RIVERA-MINDT
Organization: FORDHAM UNIVERSITY
Fiscal Year: 2024
Award: $822,437
Funding agency: National Institute on Aging
HIV remains a major public health problem, particularly for the Latina/o population. US-dwelling Latinas/os are
at increased risk for HIV-infection compared to non-Hispanic whites and suffer a disproportionate burden of
HIV-associated neurocognitive disorder (HAND) which may be amplified with age. HIV-infected (HIV+)
Latinas/os of Puerto Rican origin have the highest prevalence of HAND (~78%) of any group in the US (HIV+
Mexican Americans: 44%; African Americans: ~40%, & non-Hispanic whites: ~40%). Older HIV+ Latinas/os
(50± years) appear to be at even greater risk for HAND and cognitive decline than their non-Hispanic white
counterparts, and the pattern of cognitive impairment in HAND appears to differ by ethnicity. In the general HIV
population, HAND is characterized by impairments in processing speed, attention, and executive functioning
consistent with involvement of the frontostriatal circuitry. HIV+ Puerto Rican Latinas/os present an atypical
amnestic memory profile more consistent with medial temporal lobe (MTL) involvement. Despite these
important disparities, differing cognitive profiles and possible differences in affected neural structures, the
literature on HAND in Latinas/os is almost entirely cross-sectional, does not include HIV-uninfected (HIV-)
controls, lacks studies focused on brain integrity in this population, and has yet to examine the mechanisms
underlying these disparities. Utilizing a culturally-tailored approach, the goals of this study are to investigate
whether older HIV+ Latinas/os of Puerto Rican origin demonstrate worse patterns of decline in cognitive
function and brain integrity compared to other ethnic/HIV status groups, and to uncover the biological (e.g.,
neuroinflammatory biomarkers [sTREM2, sCD14, sTNFR-II, & IL-6], cardiovascular burden) and sociocultural
(e.g., acculturation, social adversity, stress) mechanisms conferring risk for neurodegenerative and cognitive
changes in this population. To that end, this multidisciplinary study will deploy a longitudinal observational
design with 90 HIV+ and 90 HIV-matched control adults (both groups will include: 70% Latina/o and 30% non-
Hispanic white; aged 60-80 yrs) over 36-months. All participants will complete laboratory, neuromedical,
multimodal neuroimaging, and comprehensive cognitive and sociocultural assessments. Longitudinal structural
equation models will test relationships between ethnicity, HIV, and biological and sociocultural factors on
cognition (global, learning, memory, & processing speed) and MRI brain indices (white matter lesion & MTL
gray matter volumes; MTL intrinsic activity, & hippocampal intra-network connectivity). Addressing disparities in
cognitive and brain health outcomes in Latinas/os offers a vital opportunity to elucidate HAND
neuropathogenesis, disentangle the biological and sociocultural aspects of cognitive aging through the lens of
HIV-infection, and identify modifiable factors to mitigate risk for cognitive decline. As this population is the
fastest-growing sector of the US aging population, identifying culturally-relevant intervention targets to lower
age-related cognitive morbidity in Latinas/os is key for promoting brain health equity and public health.
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disease rate><Myeloid Differentiation-Inducing Protein><NMR Imaging><NMR Tomography><Nerve Degeneration><Neurocognitive Impairment in HIV><Neurocognitive Impairment in HIV-1><Neuron Degeneration><Neuropathogenesis><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Nuclear Magnetic Resonance Imaging><Outcome><Participant><Pattern><Personalized medical approach><Plasmacytoma Growth Factor><Population><Predisposition><Primary Senile Degenerative Dementia><Public Health><Puerto Rican><Research><Risk><Risk Factors><Sampling><Scientist><Severities><Severity of illness><Stress><Structure><Susceptibility><Testing><Variant><Variation><Virus-HIV><Work><Zeugmatography><adulthood><advanced dementia><age associated><age correlated><age dependent><age linked><age related><age specific><aged><aged group><aged groups><aged individual><aged individuals><aged people><aged person><aged persons><aged population><aged populations><ages><aging associated disease><aging population><aging related disease><bio-markers><biologic><biologic marker><biomarker><brain MR imaging><brain MRI><brain health><brain magnetic resonance imaging><cerebral MR imaging><cerebral MRI><cerebral magnetic resonance imaging><cerebral vascular><cerebro-vascular><cerebrovascular><circulatory system><co-morbid><co-morbidity><cognitive change><cognitive dysfunction><cognitive function><cognitive loss><comorbidity><culturally adapted intervention><culturally appropriate intervention><culturally centered intervention><culturally focused intervention><culturally informed intervention><culturally responsive intervention><culturally tailored intervention><cytokine><design><designing><disease of aging><disease severity><disorder of aging><disparity in ethnic><disparity in health><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnicity disparity><executive control><executive function><gray matter><health disparity><health equity><high risk><hippocampal><improved><indexing><individualized approach><interferon beta 2><interventional strategy><lens><lenses><medial temporal area><medial temporal lobe><mesial temporal area><mesial temporal lobe><multi-modal neuro-imaging><multi-modal neuroimaging><multidisciplinary><multimodal neuro-imaging><multimodal neuroimaging><neural><neural degeneration><neural imaging><neural inflammation><neuro-imaging><neurodegeneration><neurodegenerative><neuroimaging><neuroinflammation><neuroinflammatory><neurological degeneration><neurological imaging><neuronal degeneration><older adult><older adulthood><personalized approach><poor health outcome><population aging><precision approach><primary degenerative dementia><processing speed><reduced health outcome><risk mitigation><senile dementia of the Alzheimer type><social adversity><social cultural factor><social culture><social culture determinant><socio-cultural><sociocultural><sociocultural determinant><sociocultural factor><substantia alba><substantia grisea><tailored approach><white matter><worse health outcome>