HIV pathogenesis, prevention and treatment in the Andes

描述（由申请人提供）：安第斯CIPRA U19提案代表了一个研究人员联盟，主要来自秘鲁研究非政府组织Impacta Salud y Educacion、秘鲁卡耶塔诺埃雷迪亚大学公共卫生学院、美国海军医学研究中心支队和美国海军。华盛顿和美国政府加州旧金山弗朗西斯科的CFAR附属教师是该提案的合作伙伴。 这次会议的主题是安第斯地区艾滋病毒的发病机制、预防和治疗。 1）通过核心A：行政和发展，（其中包括一个社区教育和发展次级核心）;核心B：生物统计、数据管理和信息学;核心C：实验室;核心D：研究开发和培训;（2）支持对安第斯地区特别重要的具体研究项目。 安第斯中心将直接支持三个主要研究项目和发展项目。 拟议的主要研究项目建立在秘鲁最近资助的四个艾滋病毒研究项目的基础上：NIH资助的HPTN、HVTN和IACTG单位，以及由惠康信托基金会和美国国际开发署-秘鲁资助的混合性传播疾病/艾滋病毒预防干预的社区随机试验（CRT）。 项目1将量化在艾滋病毒和单纯疱疹病毒合并感染的男性和女性中与单纯疱疹病毒2型再激活相关的肛门直肠和宫颈艾滋病毒脱落的增加，并将评估每日抑制性阿昔洛韦减少生殖器艾滋病毒脱落的情况;项目2将测试免疫学和病毒学结果、依从性以及每天一次抗逆转录病毒疗法在HIV（+）患者中出现ARV耐药性的比率，在开始抗逆转录病毒治疗的前6个月，比较直接观察与自我指导治疗，并比较强化与不太强化的实验室监测;项目3将评价高风险、过渡性和低风险城市人群的重复横断面抽样，以评估混合干预CRT的人群水平影响，并监测秘鲁新的2900万美元全球卫生基金方案对艾滋病毒抗逆转录病毒耐药性、艾滋病毒危险行为和发病率的影响;并将对艾滋病毒和性病感染的风险决定因素以及行为和生物干预对性病和艾滋病毒感染率的影响进行多层次分析。安第斯CIPRA有一个外部咨询委员会，由来自其他安第斯国家和美国的专家和合作者组成。

DESCRIPTION (provided by applicant): The Andean CIPRA U19 proposal represents a consortium of researchers, primarily from the Peruvian research NGO, Impacta Salud y Educacion, from the School of Public Health at Universidad Peruana Cayetano Heredia and from the US Naval Medical Research Center Detachment and the U. of Washington and the U. of California San Francisco CFAR-affiliated faculty are partners in the proposal. The theme of this CIPRA is Pathogenesis, Prevention, and Treatment of HIV in the Andean Region. The overall aims of the Andean CIPRA are to: 1) Further develop regional, institutional, and investigator capacity for HIV prevention, vaccine and treatment research through Core A: Administrative and developmental (which includes a community education and development sub-core); Core B: Biostatistics, Data Management and Informatics; Core C: Laboratory; and Core D: Research Development and Training; and to 2) Support specific research projects of particular importance to the Andean region. The Andean CIPRA will directly support three major research projects and developmental projects. The major research projects proposed build on four recently funded HIV research programs in Peru: the NIH-funded HPTN, HVTN, and IACTG Units, and a community randomized trial (CRT), funded by Wellcome Trust and by USAID-Peru, of a hybrid STD/HIV Prevention Intervention. Project 1 will quantify the increase in anorectal and cervical HIV shedding associated with HSV-2 reactivation among HIV and HSV co-infected men and women, and will assess the reduction in genital HIV shedding with daily suppressive acyclovir; Project 2 will test immunologic and virologic outcomes, adherence, and rate of emergence of ARV resistance with a once daily antiretroviral regimen in HIV (+) persons, comparing directly-observed vs. self-directed therapy in the first 6 months of ARV initiation, and comparing intensive vs. less intensive laboratory monitoring; Project 3 will evaluate repeated cross-sectional sampling of high risk, bridging, and low risk urban populations to assess population-level impact of the hybrid intervention CRT, and to monitor the impact of Peru's new $29 million Global Health Fund program on antiretroviral resistance of HIV, on risk behaviors and incidence of HIV; and will conduct multilevel analyses of risk determinants for HIV and STD infections at the level, and of the impact of behavioral and biologic interventions on STD and HIV infection rates. The Andean CIPRA has an External Advisory Committee of experts and collaborators from other Andean countries, and the U.S. [An Andean CIPRA coordination system based upon three pronged branches (the Andean government's health coordination system, the Pan American Health organization, and existing HIV research networks) will be use for expanding CIPRA activities.]