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Unlocking Hidden Concurrent Symptom Burdens and Estimating Their Associations with Health Outcomes in People Living with HIV and Co-Morbid Diabetes and Hypertension Through Topic Modeling

Award Number: R21HL184915
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2026
PERIOD OF PERFORMANCE END DATE: 08/31/2028

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Unlocking Hidden Concurrent Symptom Burdens and Estimating Their Associations with Health Outcomes in People Living with HIV and Co-Morbid Diabetes and Hypertension Through Topic Modeling - ABSTRACT In the post combined antiretroviral therapy era, identifying and managing symptoms is a primary tenet in the care of people living with HIV (PWH). Evaluation of symptom clusters as opposed to individual symptoms allows for symptom management interventions targeting multiple concurrent symptoms simultaneously, while also reducing computational complexity. Previous studies are limited in (1) sample size, resulting in inconsistent symptom clusters and limiting generalizability, (2) exploring concurrent symptom burdens among PWH with or without co-morbid diabetes and hypertension, (3) utilization of symptom clusters to differentiate PWH subgroups and subsequent health outcomes, limiting actionable clinical management, and (4) employment of advanced statistical and machine learning methods to discover clinically meaningful latent symptom clusters and their potential effects on health outcomes. In this study, we propose an innovative approach employing topic modelling, particularly the Latent Dirichlet Allocation (LDA) model, to discover latent symptom clusters and estimate their associations with key health outcomes among PWH with or without co-morbid diabetes and hypertension in the Center for AIDS Research Network of Integrated Clinical Systems, one of the largest multisite longitudinal clinical PWH cohorts in the United States. The first aim is to leverage topic modeling to identify symptom clusters and subgroups of PWH with or without diabetes and hypertension for prediction of viral failure, mortality, the Veteran Aging Cohort Study (VACS) index, and the EQ-5D quality-of-life measure. We will adapt LDA to discover symptom clusters and stratify patients by those symptom clusters. We will then conduct time-to-viral failure and time-to-mortality analyses using the Kaplan-Meier method and the Kruskal-Wallis test of the VACS and EQ-5D on the PWH subgroups. The second aim is to estimate associations between symptom cluster-based subgroups of PWH with or without diabetes and hypertension and viral failure, mortality, VACS, and EQ-5D adjusted for key patient demographic, clinical, and behavioral characteristics. We will conduct bivariate analysis to evaluate differences in these covariates across the PWH subgroups. We will then use the Cox model to analyze time-to-viral-failure and time-to-mortality and multiple linear regression to regress VACS and EQ-5D scores on the PWH subgroups adjusted for the covariates. The third aim is to develop a new topic model with covariates constrained by known diagnosis of diabetes or hypertension, to derive mixed symptom-covariate clusters and estimate their associations with health outcomes. Our exploratory study is primarily discovery-based because little is known about hidden symptom clusters and their associations with health outcomes among PWH with or without diabetes and hypertension. This study will advance our knowledge of HIV-related symptom clusters, an increasingly important clinical question as PWH age with comorbidities and co-occurring conditions. The identified symptom clusters and patient subgroups can be utilized to inform clinical care, supporting group-specific management and treatment strategies for PWH.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $234,000 )
2026	2026	UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON	7000 FANNIN ST FL 9	HOUSTON	TX	77030	HARRIS	USA	Cardiovascular Diseases Research	000	1	8/28/2026	NEW	$234,000
														Subtotal = $234,000

Grand Total All Awards = $234,000

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Unlocking Hidden Concurrent Symptom Burdens and Estimating Their Associations with Health Outcomes in People Living with HIV and Co-Morbid Diabetes and Hypertension Through Topic Modeling

Award Number: R21HL184915

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2026

PERIOD OF PERFORMANCE END DATE: 08/31/2028

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