WOMEN AND INFANTS TRANSMISSION STUDY (WITS-III)

描述：妇女和婴儿传播研究（WITS） 艾滋病病毒感染孕妇及其婴儿进入一个多中心， 流行病学队列研究，其目的是回答关键问题 与垂直传播和怀孕期间的艾滋病毒疾病有关， 婴儿期。 此外，还研究了与执行 将对这一人群进行治疗干预。 具体 WITS的目标是1）确定围产期艾滋病毒传播的机制 和与传播有关的母体辅助因素，包括 产妇用药，胎盘的作用，作用特点 艾滋病毒在产道，和产妇合并感染; 2）评估因素 与成功的围产期艾滋病毒预防战略有关， 评估尽管在围产期使用了 抗逆转录病毒药物; 3）确定妊娠对疾病进展的影响 妇女在产后期间感染艾滋病毒的比例，包括 妊娠期免疫学和病毒学变化; 4）表征急性HIV 根据抗逆转录病毒治疗， 预防和免疫治疗; 5）确定预测因素 艾滋病毒感染儿童队列中的儿科疾病进展 证人。 一个波士顿/伍斯特调查小组试图继续 参与WITS，使用相同的经验丰富的研究人员， 外地工作人员成功地为300多名孕妇和 到目前为止，有250名艾滋病毒风险的婴儿。 申请人建议扩大 共同调查员的大量专门知识， 科学顾问以及两个具体的科学合作。 他们 建议1）利用新的和敏感的技术来执行一项 对儿童HIV感染的CTL应答的详细分析， 有助于了解围产期HIV的发病机制和进展 感染以及指导免疫干预的见解;以及 （二） 探讨垂直传播的发病机制， CC趋化因子受体基因表达的个体发生，以及受体- 传播病毒的特定株系的嗜性。

DESCRIPTION: The Women and Infants Transmission Study (WITS) enrolls HIV-infected pregnant women and their infants into a multicenter, epidemiologic cohort study whose objectives are to answer critical questions relevant to vertical transmission, and to HIV disease during pregnancy and infancy. In addition, research issues relevant to implementation of therapeutic intervention in this population will be addressed. The specific aims of WITS are to 1) Determine mechanisms of perinatal HIV transmission and maternal cofactors related to transmission including the role of maternal drug use, the role of the placenta, the role and characteristics of HIV in the birth canal, and of maternal coinfections; 2) Evaluate factors related to successful perinatal HIV prevention strategies, and intensely assess transmission cases that occur despite perinatal use of antiretrovirals; 3) Determine the impact of pregnancy on disease progression of HIV infection among women through the postpartum period, including immunologic and virologic changes in pregnancy; 4) Characterize acute HIV infection among HIV-infected children in light of antiretroviral, prophylactic and immune-based therapy; 5) Determine factors predicting pediatric disease progression among the cohort of HIV infected children in WITS. A Boston/Worcester consortium of investigators seeks to continue participation in WITS, utilizing the same experienced investigators and field staff that have successfully accrued over 300 pregnant women and over 250 HIV-at risk infants to date. The applicants propose to expand on the considerable expertise of the co-investigators by the addition of basic science consultants as well as two specific scientific collaborations. They propose 1) The utilization of new and sensitive techniques to perform a detailed analysis of CTL responses to pediatric HIV infection that will be helpful in understanding the pathogenesis and progression of perinatal HIV infection as well as insights to guide immunotherapeutic intervention; and 2) To explore the pathogenesis of vertical transmission in relation to both ontogeny of expression of CC chemokine receptor genes and also to receptor - tropism of particular strains of transmitted virus.