HIV RELATED ORAL LESION IN THE ERA OF HAART

自艾滋病毒开始流行以来，我们的小组为确定和描述口腔病变在艾滋病毒疾病中的作用做出了贡献。艾滋病最初感染的是相对富裕的白人成年男同性恋者；随后，它跨越了经济、性别、种族、年龄和性别的界限。迄今为止，我们对艾滋病毒疾病自然史的研究反映了这种流行病的蔓延。他们包括静脉注射吸毒者、异性恋人群、血友病患者、妇女、儿童、青少年和少数群体的人。随着流行病的变化，特别是最近由于治疗的进步，绘制出艾滋病毒相关口腔病变频率和重要性的相应变化是很重要的。在目的1中，我们将检查使用高活性抗逆转录病毒疗法（HAART）对主要来自少数民族的青少年和成年男性和女性口腔病变患病率和发病率的影响。我们将研究HAART对艾滋病口腔病变预后的影响。在目标2中，我们将研究HAART治疗失败与口腔病变患病率之间的关系。我们将在一组无家可归者和一组青少年中进行这些研究，因为这两个群体的成员不遵守HAART将使广大人口处于治疗抵抗型艾滋病毒的高风险之中。在目标3中，我们将分析口腔病变与对念珠菌病、毛状白斑和口腔疣等病原体的特异性免疫反应之间的关系，以及与HAART使用有关的关系。我们相信，我们的流行病学研究在可用队列的规模和多样性、可用受试者数据的质量、队列研究者和我们组之间成功合作的程度和持续时间以及研究受试者本身的非凡合作和忠诚方面都是独一无二的。这些特征将我们的注意力集中在能够影响所有hiv感染者预后的研究上。

Our group has contributed to the identification and characterization of the role of oral lesions in HIV disease since the beginning of the epidemic. AIDS initially affected relatively affluent gay white adult men; subsequently, it crossed economic, sexual, ethnic, age, and gender boundaries. Our studies to date of the natural history of HIV disease have reflected his spread of the epidemic. They have included intravenous drug users, heterosexual populations, hemophiliacs, women, children, adolescents, and persons from minority groups. As the epidemic changes, most recently and notably because of therapeutic advances, it is important to chart the corresponding changes in the frequency and significance of HIV-related oral lesions. In Aim 1 we will examine the effects of use of highly active anti-retroviral therapy (HAART) on the prevalence and incidence of oral lesions in adolescent and adult men and women who primarily come from minority ethnic groups. We will examine the effect of HAART on the prognostic value of oral lesions for AIDS. In Aim 2 we will examine the association between failure of HAART and the prevalence of oral lesions. We will conduct these studies in a cohort of homeless persons and a cohort of adolescents, since non-compliance with HAART by members of both these groups places the wide population at high risk of treatment-resistance forms of HIV. In Aim 3 we will analyze the relationship between oral lesions and the specific immune response to the causative organisms off candidiasis, hairy leukoplakia, and oral warts, in relation to HAART use. We believe that our epidemiologic studies are unique with regard to the size and diversity of the cohorts available the quality of data available on the subjects, the extent and duration of the successful collegial interaction between the cohort investigators and our group, and the extraordinary level of cooperation and loyalty of the study subjects themselves. These characteristics focus our attention on research that can affect the prognosis of all HIV-infect persons.