Retrovial Infections of the Nervous System in Peru

描述（由申请人提供）：这项RO1申请的总体目标是研究秘鲁神经系统逆转录病毒、机会性感染和热带感染的临床流行病学和发病机制，以R21资助期间发起的研究合作和调查为基础，题为“秘鲁中枢神经系统感染”；并在秘鲁选定城市的学术和研究机构中继续培养神经学家调查员。这笔赠款的具体目标是：1)确定秘鲁四个最大城市中HTLV-II、HTLV-I、艾滋病毒感染的风险决定因素和临床表现，以及同时感染这三种逆转录病毒病原体中的两种或两种以上的情况；2)建立国家HTLV感染临床研究参考中心，对血库转诊人员HTLV- i和-II感染的自然病史、临床表现和发病机制进行队列研究；3)检查这三种逆转录病毒感染对逆转录病毒感染者中枢神经系统机会性感染和热带感染的自然史的影响。在我们的R21规划拨款期间，我们发现htmv - ii感染在利马（首都）和亚马逊丛林中两个最大城市的选定人群中意外流行。此外，我们与利马（首都）、伊基托斯（丛林）、阿雷基帕（安第斯山脉）和特鲁希略（海岸）的神经学家开展了研究合作，并确定了伊基托斯和阿雷基帕最常见的神经艾滋病表现；并通过会议和国内培训，为200多名经验丰富和新的临床研究人员提供研究和人体受试者培训，其中许多是神经科医生。与此同时，威斯康星大学领导的秘鲁艾滋病毒/艾滋病相关研究经费已从国家卫生研究院和私人基金会增加到每年500万美元，为进一步发展中枢神经系统逆转录病毒研究项目奠定了良好的基础。由秘鲁非政府机构和卫生部的研究人员、秘鲁的美国海军医学研究中心支队（NMRCD）以及秘鲁和美国的大学共同建立的热带神经传染病合作网络，将支持未来关于逆转录病毒感染的临床流行病学及其与秘鲁乃至安第斯地区新出现的热带感染的相互作用的研究。除了继续调查外，我们计划继续开展培训活动，以解决R21计划拨款期间确定的与中枢神经系统感染相关的研究、教育、培训和指导需求和机会。

DESCRIPTION (provided by applicant): The overarching goals of this RO1 application are to study the clinical epidemiology and pathogenesis of retroviral, opportunistic and tropical infections of the nervous system in Peru, building on research collaborations and investigations initiated during the R21 grant entitled "Central Nervous System Infections in Peru"; and to continue development of neurologist investigators in academic and research institutions in selected cities throughout Peru. The specific aims of this grant are to 1) define the risk determinants and clinical manifestations of HTLV-II, HTLV-I, HIV infections and of coinfections with two or more of these three retroviral pathogens in the four largest cities in Peru; 2) establish a national reference center for clinical research on HTLV infection for conduct of cohort studies of the natural history, clinical manifestations, and pathogenesis of HTLV-I and -II infections in persons referred from blood banks; and 3) examine the influence of these three retroviral infections on the natural history of opportunistic and tropical infections of the CNS in persons with retroviral infection. During our R21 planning grant, we discovered that HTLV-II infection was unexpectedly prevalent in selected populations in Lima (the capital) and two of the largest cities in the Amazon Jungle. In addition, we developed research collaborations with neurologists in Lima (the capital), Iquitos (Jungle), Arequipa (Andes Mountains), and Trujillo (Coast), and determined the most common manifestations of neuroAIDS in Iquitos and Arequipa; and through conferences and in-country training, provided research and human subjects training to over 200 experienced and new clinical investigators - many of them neurologists. Concurrently, UW-led HIV/AIDS-related research funding in Peru has grown to $5,000,000 per year from NIH and from private foundations, providing an outstanding foundation for further development of a CNS retroviral research program. The Collaborative Network for Tropical Neurologic Infectious Diseases established with researchers in nongovernmental and Ministry of Health institutions in Peru, with the U.S. Naval Medical Research Center Detachment (NMRCD) in Peru, and with Universities in Peru and the United States, will support future research on the clinical epidemiology of retroviral infections and their interactions with emerging tropical infections in Peru and eventually the Andean Region. In addition to continuing our investigations, we plan to continue training activities to address the research, education, training, and mentoring needs and opportunities related to CNS infection identified during the R21 planning grant.