AHA Fellowship for Adovich Rivera in Support of Role of Social Determinants in Disease Control and Cardiometabolic Risk of People with Human Immunodeficiency Virus

People with the human immunodeficiency virus (PHIV) have over double the risk of acquiring cardiovascular diseases (CVD) compared to HIV-uninfected persons. Aside from addressing traditional cardiovascular risk factors and cardio-metabolic conditions, PHIV also need to achieve viral suppression to mitigate their cardiovascular risk. Unfortunately, due to social and health system challenges (e.g. stigma, insurance), rates of disease control (e.g. viral suppression) among PHIV remains suboptimal and can be difficult to achieve especially for marginalized populations. Current care needs to be made more responsive in aiding PHIV to achieve better control but knowledge of the drivers of control remains limited. Previous research has focused on factors influencing the achievement of disease control targets (e.g. viral suppression) at one point in time instead of achieving sustained control or suppression. In addition, the risk for and control of cardio-metabolic conditions and their association to HIV control has been inadequately examined. By analyzing real-world data from electronic health records of two complementary health care systems catering to PHIV with different socio-demographic profiles, I aim to better understand how social and systemic factors affect sustained disease control and CV risk in this population and address the following aims: Aim 1: Identify clinical and socio-demographic predictors of retention in care and HIV disease control trajectory patterns among PHIV who receive care, Aim 2: Estimate the risk of acquiring cardio-metabolic conditions (CMC) (diabetes mellitus, hypertension, dyslipidemia) associated with different HIV control trajectory patterns, and Aim 3: Examine the degree of co-variation in HIV control with cardio-metabolic disease control and identify factors associated with co-variation among PHIV with co-morbid diseases. The knowledge gained can help us design better cardiovascular services for PHIV and help this vulnerable population i