HIV RELATED ORAL LESION IN THE ERA OF HAART

自艾滋病流行开始以来，我们小组为确定口腔病变在艾滋病毒疾病中的作用作出了贡献。艾滋病最初影响的是相对富裕的同性恋成年白人男性；随后，它跨越了经济、性别、种族、年龄和性别的界限。到目前为止，我们对艾滋病毒疾病自然历史的研究反映了他的流行病的传播。他们包括静脉注射吸毒者、异性恋人群、血友病患者、妇女、儿童、青少年和少数群体。随着疫情的变化，尤其是最近和明显的治疗进展，重要的是绘制与艾滋病毒相关的口腔病变的频率和重要性的相应变化图表。在目标1中，我们将研究使用高效抗逆转录病毒疗法(HAART)对主要来自少数族裔的青少年和成年男性和女性口腔病变的患病率和发病率的影响。我们将研究HAART对口腔病变对艾滋病预后的影响。在目标2中，我们将研究HAART失败与口腔病变发生率之间的关系。我们将在一群无家可归的人和一群青少年中进行这些研究，因为这两个群体的成员不遵守HAART会使广大人口面临耐药艾滋病毒的高风险。在目标3中，我们将分析口腔损伤与使用HAART相关的念珠菌病、毛状白斑和口腔尖锐湿疣的致病微生物的特异性免疫反应之间的关系。我们相信，我们的流行病学研究在以下方面是独一无二的：可用队列的规模和多样性、可用受试者数据的质量、队列调查人员和我们组之间成功的合作互动的程度和持续时间，以及研究对象本身非凡的合作和忠诚度。这些特征将我们的注意力集中在可能影响所有艾滋病毒感染者预后的研究上。

Our group has contributed to the identification and characterization of the role of oral lesions in HIV disease since the beginning of the epidemic. AIDS initially affected relatively affluent gay white adult men; subsequently, it crossed economic, sexual, ethnic, age, and gender boundaries. Our studies to date of the natural history of HIV disease have reflected his spread of the epidemic. They have included intravenous drug users, heterosexual populations, hemophiliacs, women, children, adolescents, and persons from minority groups. As the epidemic changes, most recently and notably because of therapeutic advances, it is important to chart the corresponding changes in the frequency and significance of HIV-related oral lesions. In Aim 1 we will examine the effects of use of highly active anti-retroviral therapy (HAART) on the prevalence and incidence of oral lesions in adolescent and adult men and women who primarily come from minority ethnic groups. We will examine the effect of HAART on the prognostic value of oral lesions for AIDS. In Aim 2 we will examine the association between failure of HAART and the prevalence of oral lesions. We will conduct these studies in a cohort of homeless persons and a cohort of adolescents, since non-compliance with HAART by members of both these groups places the wide population at high risk of treatment-resistance forms of HIV. In Aim 3 we will analyze the relationship between oral lesions and the specific immune response to the causative organisms off candidiasis, hairy leukoplakia, and oral warts, in relation to HAART use. We believe that our epidemiologic studies are unique with regard to the size and diversity of the cohorts available the quality of data available on the subjects, the extent and duration of the successful collegial interaction between the cohort investigators and our group, and the extraordinary level of cooperation and loyalty of the study subjects themselves. These characteristics focus our attention on research that can affect the prognosis of all HIV-infect persons.