HIV pathogenesis, prevention and treatment in the Andes

描述（由申请人提供）：安第斯CIPRA U19提案代表了一个研究人员联盟，主要来自秘鲁研究非政府组织“影响健康与教育”，来自秘鲁大学卡亚塔诺埃雷迪亚公共卫生学院，来自美国海军医学研究中心支队，华盛顿大学和加州大学旧金山分校cfar附属教师是该提案的合作伙伴。本次CIPRA的主题是安第斯地区艾滋病毒的发病机制、预防和治疗。安第斯CIPRA的总体目标是：1)通过核心A：行政和发展（其中包括社区教育和发展分核心）进一步发展艾滋病毒预防、疫苗和治疗研究的区域、机构和研究者能力；核心B：生物统计学、数据管理与信息学；核心C：实验室；核心D：研究发展和培训；2)支持对安第斯地区特别重要的具体研究项目。安第斯CIPRA将直接支持三个主要研究项目和发展项目。提出的主要研究项目以秘鲁最近资助的四个艾滋病毒研究项目为基础：由美国国立卫生研究院资助的HPTN、HVTN和IACTG单位，以及由威康信托基金和美国国际开发署秘鲁办事处资助的性病/艾滋病毒混合预防干预社区随机试验（CRT）。项目1将量化艾滋病毒和HSV合并感染的男性和女性中与HSV-2再激活相关的肛门直肠和宫颈艾滋病毒脱落的增加，并将评估每日使用抑制性阿昔洛韦减少生殖器艾滋病毒脱落的情况；项目2将测试HIV（+）患者每日一次抗逆转录病毒治疗方案的免疫学和病毒学结果、依从性和ARV耐药性的出现率，比较在ARV开始治疗的前6个月直接观察与自我指导治疗，并比较强化与不强化的实验室监测；项目3将评估对高风险、过渡性和低风险城市人口的重复横断面抽样，以评估混合干预CRT在人口层面的影响，并监测秘鲁新的2 900万美元全球卫生基金方案对艾滋病毒抗逆转录病毒耐药性、风险行为和艾滋病毒发病率的影响；并将对艾滋病毒和性病感染的风险决定因素进行多层次分析，以及行为和生物干预对性病和艾滋病毒感染率的影响。安第斯CIPRA有一个外部咨询委员会，由来自其他安第斯国家和美国的专家和合作者组成[将利用基于三个分支机构（安第斯政府的卫生协调系统、泛美卫生组织和现有的艾滋病毒研究网络）的安第斯CIPRA协调系统扩大CIPRA的活动。]

DESCRIPTION (provided by applicant): The Andean CIPRA U19 proposal represents a consortium of researchers, primarily from the Peruvian research NGO, Impacta Salud y Educacion, from the School of Public Health at Universidad Peruana Cayetano Heredia and from the US Naval Medical Research Center Detachment and the U. of Washington and the U. of California San Francisco CFAR-affiliated faculty are partners in the proposal. The theme of this CIPRA is Pathogenesis, Prevention, and Treatment of HIV in the Andean Region. The overall aims of the Andean CIPRA are to: 1) Further develop regional, institutional, and investigator capacity for HIV prevention, vaccine and treatment research through Core A: Administrative and developmental (which includes a community education and development sub-core); Core B: Biostatistics, Data Management and Informatics; Core C: Laboratory; and Core D: Research Development and Training; and to 2) Support specific research projects of particular importance to the Andean region. The Andean CIPRA will directly support three major research projects and developmental projects. The major research projects proposed build on four recently funded HIV research programs in Peru: the NIH-funded HPTN, HVTN, and IACTG Units, and a community randomized trial (CRT), funded by Wellcome Trust and by USAID-Peru, of a hybrid STD/HIV Prevention Intervention. Project 1 will quantify the increase in anorectal and cervical HIV shedding associated with HSV-2 reactivation among HIV and HSV co-infected men and women, and will assess the reduction in genital HIV shedding with daily suppressive acyclovir; Project 2 will test immunologic and virologic outcomes, adherence, and rate of emergence of ARV resistance with a once daily antiretroviral regimen in HIV (+) persons, comparing directly-observed vs. self-directed therapy in the first 6 months of ARV initiation, and comparing intensive vs. less intensive laboratory monitoring; Project 3 will evaluate repeated cross-sectional sampling of high risk, bridging, and low risk urban populations to assess population-level impact of the hybrid intervention CRT, and to monitor the impact of Peru's new $29 million Global Health Fund program on antiretroviral resistance of HIV, on risk behaviors and incidence of HIV; and will conduct multilevel analyses of risk determinants for HIV and STD infections at the level, and of the impact of behavioral and biologic interventions on STD and HIV infection rates. The Andean CIPRA has an External Advisory Committee of experts and collaborators from other Andean countries, and the U.S. [An Andean CIPRA coordination system based upon three pronged branches (the Andean government's health coordination system, the Pan American Health organization, and existing HIV research networks) will be use for expanding CIPRA activities.]