EPIDEMIOLOGY OF ORAL MANIFESTATIONS OF HIV DISEASE

我们提出了三组关于口语表达的研究 HIV感染者的病变，不同于分子 从流行病学到传统的流行病学。这些分析将 基于6项队列研究和1个临床人群；3 队列跟踪来自血清转换的受试者(三个连续的 SERO转换器研究、HIVNET和S.F.Men的子集 健康研究)。研究人群包括青少年、妇女 以及通过性行为或注射毒品感染艾滋病毒的男性 使用。 目前，艾滋病毒病毒载量和口腔损伤都在使用 作为抗逆转录病毒临床试验的结果指标 然而，这些治疗结果之间的关系 没有被刻画出来。在目标1下，我们将研究这一点 正在测量病毒载量的三个队列中的关系 连续地。如果我们表现出很强的关联性，那么 口腔病变作为疾病进展的标志的有用性是 增强，部分原因是定期临床检查远 比病毒载量分析便宜。 口腔病变对HIV进展的预后价值 疾病导致了它们在定义CDC分类时的使用 关于艾滋病毒疾病和五氯苯酚的预防措施。这项研究的大部分内容 是基于同性恋/双性恋男性的队列，其中一些 这并没有区分口腔损伤的类型。我们 观察到病变类型的患病率有显著差异 按风险组划分，这可能会影响他们在 HIV的临床试验和作为治疗管理的基础 疾病。在目标2下，我们继续研究发病率， 按危险组分组的口腔病变的预后价值和危险因素。 临床医生报告的唑类耐药病例越来越多。 在HIV感染的受试者中，CD4计数非常低。 通过更换敏感分离物而产生的抗性 与来自不同物种的抗性分离株一起提高了 人与人之间传播的作用和 预防原发感染的潜力。在目标3下，我们 建议开展耐唑念珠菌病病例对照研究 用钙离子探针对分离株进行DNA指纹分析。

We propose three sets of studies of the expression of oral lesions by HIV-infected people, varing from molecular epidemiology to traditional epidemiology. These analyses will be based on six cohort studies and one clinic population; three cohorts follow subjects from seroconversion (Tricontinental Seroconverter Study, HIVNET, and a subset of the S.F. Men's Health Study). The study populations include adolescents, women and men, who were infected with HIV through sex or injection drug use. Currently, both HIV viral load and oral lesions are being used as outcome measures in clinical trials of antiretroviral treatments, however, the relationship between these outcomes has not been characterized. Under Aim 1 we will study this relationship in three cohorts whose viral load is being measured serially. If we demonstrate a strong association, then the usefulness of oral lesions as markers of disease progression is enhanced, in part because periodic clinical examinations are far less expensive than viral load assays. The prognostic value of oral lesions for progression of HIV disease has led to their use in defining the CDC classification of HIV disease and prophylaxes for PCP. Much of this research has been based on cohorts of homosexual/bisexual men, some of which has not distinguished between types of oral lesions. We have observed striking differences in prevalence of lesion types by risk group, which may have implications for their role in clinical trails and as bases for therapeutic management of HIV disease. Under Aim 2 we continue our studies of the incidence, prognostic value, and risk factors of oral lesions by risk group. Clinicians increasingly are reporting cases of azole resistance among HIV-infected subjects with very low CD4 counts. Resistance arising through replacement of a susceptible isolate with a resistant isolate from a different species raises the question of the role of person-to-person transmission and the potential for prevention of primary infection. Under Aim 3 we propose to conduct a case-control of azole-resistant candidiasis with DNA fingerprinting of isolates using the Ca2 probe.