NATURAL HISTORY OF HIV-1 INFECTION IN HOMOSEXUAL AND BISEXUAL MEN

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The Study to Help the AIDS Research Effort (SHARE) was funded for an additional four years in 1995. We continue to utilize the OPD-GCRC as the primary source of data collection (blood specimens, physical, and questionnaire. Clinic is held two evenings a week, with special arrangements made for participants who are unable to make regular clinic hours. Long-term substudies (Neuropsychological) and new studies are coordinated in and out of the primary study on a regular basis. Current research focuses on all aspects of HIV infection and progression to disease. Immunologic studies initiated in previous years are continuing and include the investigation of the hypothesis of blind T cell homeostasis which postulates the existence of a physiologic mechanism that maintains constant numbers of T lymphocytes in the peripheral blood. The failure of this mechanism occurs approximately two year's AIDS (clinical definition) on the average. Dr. Joseph Margolick, who heads the MACS pathogenesis laboratory, along with collaborators from other sites, has been studying individual subjects with failure of T cell homeostasis to try to understand the mechanism of this failure. The neuropsychological study has been screening participants since 1987. More than 200 HIV seropositive participants were tested in 1996. In addition, detailed neurological assessments were performed on 46 participants half of these occurred in a special Saturday clinic. This research has provided insights into the effects of HIV infection on neurological function. Adamson, et al., showed that severe HIV dementia was associated with significant elevations in brain levels of immunologic nitric oxide and gp4 1. This study is important because it associates elevations in brain levels of HIV proteins with immunologic activation and may provide important clues to unraveling the pathophysiological mechanism of HIV associated dementia. Dr Alfred Saah, the study principal investigator, has been involved with several research initiatives within the study. These include the investigation of the role of micro nutrients in HIV-1 disease progression and the progression of HIV- I disease in gay men with no access to treatment. He presented data at the XI International Conference on AIDS which showed that the TRAX CD4 Kit ( an EIA test) is an effective method for measuring T- helper counts when compared with the conventional method of flow cytometry. The cohort continues to serve as a resource to investigators who have an interest in studying HIV infection at all stages.