UAB-MISS WIHS Cohort

描述(申请人提供)：随着艾滋病流行的成熟，在美国东南部发生了不成比例的新感染人数。因此，妇女机构间艾滋病毒研究(WIHS)队列正在扩大，将东南部的一个新地点包括在内，以使队列更具代表性。阿拉巴马州和密西西比州位于南部腹地，每年新增艾滋病毒病例的比例最高，特别是在少数族裔妇女中。获得医疗服务的障碍在美国是最严重的，肥胖症、心血管疾病、癌症和医疗保健差距的流行最为明显。因此，在该国这一地区建立一个新的WIHS站点将提供机会来评估今天正在出现的艾滋病的“新”流行。阿拉巴马大学伯明翰分校(UAB)在艾滋病研究方面有着丰富的传统，可以追溯到20世纪80年代中期。随着疫情的成熟，UAB的科学家已经在传播疫情的社会行为因素方面建立了专业知识，包括检测障碍、与护理的联系、护理中的保留和污名。UAB的科学家已经成为创新队列研究的领导者，这些研究通过多点队列研究(例如，CNICs、NA-ACCORD、ART-CC和FRAM)来评估方案的长期结果和比较有效性。通过与密西西比大学医学中心(UMMC)建立联系作为子单位合作伙伴，我们充分利用了他们在艾滋病毒临床护理、外展和队列研究方面的多年专业知识。总体而言，我们代表了WIHS的理想补充，无论是在科学专业知识方面，还是在美国当前艾滋病毒流行的代表性方面。我们新的WIHS网站的具体目标是：1.评估在南方腹地新近确诊的妇女中，艾滋病毒预防行为、检测、与护理的联系和保持护理的心理社会障碍。2.探讨激素避孕药和体脂含量对HIV-1感染妇女免疫功能亢进和加速衰老的影响。3.确定HPV共存亚种与阴道微生物群之间的相互作用，为宫颈不典型增生和恶性肿瘤的表达创造有利条件。4.探讨慢性HIV感染和治疗对肠道微生物群(‘失调’)的影响。5.阐明导致肥胖在感染艾滋病毒的妇女中迅速成为一种高度流行的疾病的营养、宿主遗传、代谢和文化因素6.招募和保留300名妇女，其中一半是艾滋病毒血清阳性者，另一半是匹配良好的艾滋病毒阴性对照，他们是经过战略选择的，以便能够开展上述拟议的研究项目，同时满足WIHS队列的需要。

DESCRIPTION (provided by applicant): As the AIDS epidemic has matured a disproportionate number of new infections are occurring in the Southeastern US. As such, the Women's Interagency HIV Study (WIHS) cohort is expanding to include a new site in the Southeast to make the cohort more representative. Alabama and Mississippi are located in the heart of the Deep South and have some of the highest rates of new HIV cases annually, especially among minority women. Barriers to access to care are among the worst in the US, and the prevalence of obesity, cardiovascular disease, cancer, and health care disparities most pronounced. Therefore, establishing a new WIHS site in this area of the country will provide the opportunity to assess the 'new' epidemic of AIDS as it is emerging today. The University of Alabama at Birmingham (UAB) has a rich tradition of AIDS research, dating back to the mid-1980s. As the epidemic has matured, UAB scientists have established expertise in the socio-behavioral factors that propagate the epidemic, including barriers to testing, linkage to care, retention in care, and stigma. UAB scientists have emerged as leaders in innovative cohort research that evaluate the long term outcomes and comparative effectiveness of regimens via multisite cohort studies (e.g., CNICS, NA-ACCORD, ART-CC, and FRAM). By creating a linkage to the University of Mississippi Medical Center (UMMC) as a subunit partner, we take full advantage of their years of expertise in HIV clinical care, outreach, and cohort research. Collectively, we represent an ideal addition for WIHS both in terms of scientific expertise and representation of the current HIV epidemic in the US. The Specific Aims for our new WIHS site are: 1. To assess psychosocial barriers to HIV prevention behaviors, testing, linkage to care, and retention in care among recently diagnosed women in the Deep South. 2. To evaluate the influence of hormonal contraception and body fat mass on immune hyperactivation and accelerated immunosenescence in HIV-1 infected women. 3. To determine the interplay between co-existing HPV subspecies and the vaginal microbiome in creating conditions favorable to the expression of cervical dysplasia and malignancy 4. To explore changes in the gut microbiome ('dysbiosis') occurring as a consequence of chronic HIV infection and its treatment. 5. To elucidate nutritional, host genetic, metabolic, and cultural factors that are contributing to the rapid emergence of obesity as a highly prevalent condition among HIV infected women 6. To recruit and retain a cohort of 300 women, half of whom are HIV seropositive and half well-matched HIV-negative controls, who are strategically selected to enable the conduct of the research projects proposed above while simultaneously meeting the needs of the WIHS cohort.