Retrovial Infections of the Nervous System in Peru

描述(由申请人提供)：该RO1申请的总体目标是研究秘鲁神经系统逆转录病毒、机会性和热带感染的临床流行病学和发病机制，以R21赠款期间发起的题为“秘鲁的中枢神经系统感染”的研究合作和调查为基础；并在秘鲁各地选定的城市的学术和研究机构继续发展神经学家研究人员。这笔赠款的具体目的是1)确定HTLV-II、HTLV-I、HIV感染的风险决定因素和临床表现，以及在秘鲁四个最大的城市与这三种病原体中的两种或两种以上合并感染的风险决定因素和临床表现；2)建立国家HTLV感染临床研究参考中心，对血库转诊患者的HTLV-I和HTLV-II感染的自然病史、临床表现和发病机制进行队列研究；以及3)研究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和热带感染自然病史的影响。在我们的R21规划拨款期间，我们发现HTLV-II感染出人意料地在利马(首都)和亚马逊丛林中两个最大的城市的选定人群中流行。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)的神经科医生建立了研究合作关系，并确定了伊基托斯和阿雷基帕最常见的神经艾滋病表现；通过会议和国内培训，向200多名经验丰富的和新的临床研究人员提供了研究和人类学科培训，其中许多是神经科医生。与此同时，密歇根州立大学领导的秘鲁艾滋病毒/艾滋病相关研究资金已从国立卫生研究院和私人基金会提供的资金增至每年500万美元，为进一步发展中枢神经系统逆转录病毒研究计划奠定了坚实的基础。与秘鲁非政府组织和卫生部机构的研究人员、秘鲁的美国海军医学研究中心支队以及秘鲁和美国的大学建立的热带神经传染病合作网络将支持未来对逆转录病毒感染的临床流行病学及其与秘鲁和安第斯地区新出现的热带感染的相互作用的研究。除了继续我们的调查外，我们还计划继续培训活动，以满足在R21规划拨款期间确定的与CNS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.