Primary Infection Resource Consortium (PIRC)

摘要 艾滋病毒在美国的发病率仍在上升，尽管作出了巨大努力：(I)尽早诊断艾滋病毒感染 可能，(2)让新诊断的人接受护理和(3)为所有人开始抗逆转录病毒治疗(ART) 感染者。圣地亚哥初级感染资源联盟(PIRC)一直在解决 二十年来围绕这些问题不断演变的挑战。PIRC是规模最大、研究最深入的 和特征良好的美国急性和早期艾滋病毒感染(AEH)人群。它有 为超过325篇同行评审的原创研究手稿提供基本支持，涉及广泛的 领域，包括美国国立卫生研究院艾滋病毒研究的许多优先领域，包括：艾滋病毒发病率、改进战略 艾滋病毒检测和进入预防服务等。这项申请代表着我们的PIRC R24的更新 (AI106039)提议继续这一高产计划，支持所需的基础设施 识别、描述临床和生物数据，并与其研究成果的科学同事共享 目标有赖于获得这些生物样本和数据。建议的R24续订申请 包括PIRC和艾滋病研究中心(CFAR)之间的新合作 临床系统(CNICs)将开发扩展和协同的资源，以服务于 AEH的面积。总体而言，PIRC支持：1)艾滋病毒筛查计划，以检测和分期急性、新近 和慢性感染，2)伙伴服务，以确定新诊断的AEH参与者的性接触 (即“索引”受试者)，3)立即提供抗逆转录病毒治疗，4)迅速与护理挂钩，5)监测抗逆转录病毒治疗 坚持和持续参与护理，6)估计假定的艾滋病毒传播的方法和6) AEH生物库。与这些特征良好的参与者相关的整个生物信息库和数据是 可供合格的调查人员使用，只需对概念提案进行内部审查和批准。这个 拟议的R24续期申请将涉及以下具体目标：目标1.社区艾滋病毒检测 和急性和早期艾滋病毒(AEH)感染分期。我们建议识别120名新确诊的爱滋病病毒感染者 在加州大学圣地亚哥分校，每年有47名AEH感染者和73名慢性感染者。 目的2.提高艾滋病防治工作的连贯性。我们将评估时间变化在 响应支持新诊断艾滋病毒患者立即抗逆转录病毒治疗的协调努力，艾滋病毒治疗级联反应 Pirc参与者。在AEH期间确诊的受试者将在慢性感染期间接受长达5年的跟踪调查 受试者将在诊所接受长达90天的跟踪调查。目标3.共享资源。我们将利用AEH 样本和参与者资源，以支持与初级艾滋病毒相关的更多NIH研究合作 感染。CNICs中AEH参与者的共同登记将利用经验证的临床监测 CNICs提供的结果和纵向耐药性数据。PIRC将作为一个资源来支持 与AEH相关的高质量基础、临床和转化性研究。

ABSTRACT HIV incidence is still increasing in the U.S. despite intense efforts to: (i) diagnose HIV infection as early as possible, (ii) engage newly diagnosed individuals into care and (iii) start antiretroviral therapy (ART) for all infected persons. The San Diego Primary Infection Resource Consortium (PIRC) has been tackling the evolving challenges around these issues for twenty years. The PIRC is the largest, most intensively studied and well-characterized cohort of acute and early HIV infected (AEH) individuals in the United States. It has provided essential support to over 325 peer-reviewed original research manuscripts, spanning a wide range of fields, and including many NIH priority areas for HIV research, including: HIV incidence, strategies to improve HIV testing and entry into prevention services, etc. This application represents a renewal of our PIRC R24 (AI106039) with the proposal to continue this highly productive program, supporting the infrastructure needed to identify, characterize, and share clinical and biological data with scientific colleagues whose research objectives rely upon access to these biological samples and data. The proposed R24 renewal application includes a new collaboration between PIRC and the Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) to develop an expanded and synergistic resource to serve biomedical research in the area of AEH. Overall, the PIRC supports: 1) an HIV screening program to detect and stage acute, recent and chronic infection, 2) partner services to identify sexual contacts of newly HIV diagnosed AEH participants (i.e., “index” subjects), 3) immediate provision of ART, 4) prompt linkage to care, 5) monitoring of ART adherence and continued engagement in care, 6) methods to estimate putative HIV transmission and 6) an AEH biorepository. This entire biorepository and data associated with these well characterized participants are available to qualified investigators, requiring only internal review and approval of a concept proposal. The proposed R24 renewal application will address the following Specific Aims: Aim 1. Community HIV Testing and Acute and Early HIV (AEH) Infection Staging. We propose to identify 120 newly HIV diagnosed persons per year at the University of California San Diego: 47 AEH infected and 73 chronically infected participants. Aim 2. Improve Continuum of HIV Prevention and Treatment. We will evaluate temporal changes in the HIV treatment cascade in response to coordinated efforts to support immediate ART in newly HIV diagnosed PIRC participants. Subjects identified during AEH will be followed for up to 5 years, while chronically infected subjects will be followed in clinic for up to 90 days. Aim 3. Shared Resources. We will leverage AEH specimen and participant resources to support additional NIH research collaborations related to primary HIV infection. Co-enrollment of AEH participants in CNICS will leverage the clinical monitoring of validated outcomes and longitudinal resistance data provided by CNICS. The PIRC will serve as a resource to support high quality basic, clinical and translational research related to AEH.