HIV/HPV Cancer Prevention, Treatment & Pathogenesis: Rwanda/Einstein Consortium

由于有效的抗逆转录病毒疗法（ART），数百万感染艾滋病毒的非洲人寿命延长， 包括癌症在内的老年疾病将会增加。人乳头瘤病毒（HPV）是一种致病因子， 几乎所有的宫颈癌和肛门癌，以及约50%的头颈癌。子宫颈癌是艾滋病的定义 恶性肿瘤，是世界范围内女性癌症死亡的最常见原因，如果不通过预防， 筛选程序。在HIV感染的妇女中，HPV的转化能力增强，其HPV相关的 子宫颈病变更普遍，更容易发展，更容易成为癌症。HPV 也会引起肛门粘膜的变形。与艾滋病相关的卡波西肉瘤和非霍奇金病不同， 淋巴瘤、宫颈癌和肛门癌的发病率并没有随着抗逆转录病毒疗法的采用而下降， 在感染艾滋病毒的妇女和男子中仍然高出数倍。我们提议成立一个阿尔伯特研究联盟 爱因斯坦医学院与卢旺达大学（UR-学术合作伙伴）和卢旺达军队 医院（RMH-临床合作伙伴）调查非洲艾滋病毒/HPV相关癌症。与我们的学员一起工作 和合作伙伴，并继续建立我们的研究基础设施，所有这些都是通过我们的 NCI/Fogarty资助的（D43）项目“发展卢旺达艾滋病研究能力”，我们将 开发一个平台，建立卢旺达-爱因斯坦联合会，作为艾滋病毒/人乳头瘤病毒相关的区域资源 临床、转化和操作研究。我们将研究筛选的最佳方法， 预防感染艾滋病毒的卢旺达妇女的宫颈癌，并评估不同的成本效益 结合分子检测预测宫颈疾病。我们还将建立一支卢旺达 男男性行为者（MSM），以确定艾滋病毒的流行率，特定类型的HPV（肛门和阴茎） 和肛门肿瘤，并跟踪他们两年，以评估艾滋病毒，HPV和肛门疾病的发病率。我们 将继续开发我们的临床合作伙伴RMH的人类和物理病理学资源;建立一个 PCR实验室可以进行HPV DNA分型，但可以灵活部署，以评估其他病原体。 我们将加强RMH和UR的研究办公室，目标是向它们转移 随着时间的推移，联盟的行政和财务管理以及领导。该财团 资源将允许未来评估重要的HPV相关临床问题，如发现的HPV类型 在接种了艾滋病毒+和艾滋病毒阴性的卢旺达年轻妇女中，HPV对头颈部的贡献 HIV+的癌症

As millions of HIV-infected Africans live longer due to effective antiretroviral therapy (ART), their incidence of diseases of aging, including cancer, will increase. Human papillomavirus (HPV) is the causal agent for almost all cervical and anal cancers, and ~50% of head and neck cancers. Cervical cancer, an AIDS-defining malignancy, is the most common cause of cancer deaths in women worldwide if not prevented through screening programs. The transforming capability of HPV is enhanced in HIV-infected women, whose HPV-related cervical lesions are more prevalent, more likely to progress, and more likely to become cancer. HPV also causes transformation of the anal mucosa. Unlike AIDS related Kaposi's Sarcoma and non-Hodgkin's Lymphoma, the incidence of cervical and anal cancers has not declined with the introduction of ART and remains elevated several fold in HIV-infected women and men. We propose a research consortium of Albert Einstein College of Medicine with the University of Rwanda (UR-academic partner) and Rwanda Military Hospital (RMH-clinical partner) to investigate HIV/HPV related cancers in Africa. Working with our trainees and partners and continuing to build upon our research infrastructure, all accomplished through our NCI/Fogarty-funded (D43) program "Developing Rwandan Research Capacity in AIDS Malignancies", we will develop a platform establishing the Rwanda-Einstein Consortium as a regional resource for HIV/HPV related clinical, translational and operational research. We will investigate the optimal approach for screening and prevention of cervical cancer in HIV-infected Rwandan women, and assess the cost-effectiveness of different combinations of molecular tests in predicting cervical disease. We will also establish a cohort of Rwandan men who have sex with men (MSM) to determine the prevalence of HIV, type-specific HPV (anal and penile) and anal neoplasia, and follow them for two years to assess incidence of HIV, HPV and anal disease. We will continue to develop the human and physical pathology resources of our clinical partner RMH; establish a PCR laboratory that can perform HPV DNA typing but can be flexibly deployed to assess other pathogens. We will strengthen the Research Offices of RMH and UR with the goal of transferring to them the administrative and financial management and leadership of the Consortium over time. The Consortium resources will allow future assessment of important HPV-related clinical questions, such as HPV types found in vaccinated HIV+ and HIV-negative young Rwandan women, the contribution of HPV to head and neck cancers in HIV+.