HIV-related oral diseases among women in Harare

描述（由申请人提供）：作为母项目P01-DE 07946（PI：John Greenspan）的最后一个竞争性更新申请的一部分，我们试图解决有关艾滋病毒/艾滋病口腔表现的新问题。迄今为止，我们的研究主要集中在美国的艾滋病毒感染人群。然而，我们建议，作为目前FIRCA申请的一部分，扩大我们对艾滋病毒感染的口腔表现的作用和意义的研究，到目前为止一直研究不足的环境：撒哈拉以南非洲。由于成本过高，在撒哈拉以南非洲国家很少能够获得测量艾滋病毒疾病进展的生物测定，因此需要其他较便宜的监测疾病进展的手段。在美国人群中，已发现对口腔的目视检查和对选定口腔粘膜病变的诊断是HIV疾病进展的良好预测因素。如果口腔检查的预测作用能够在撒哈拉以南非洲得到证实，这将为临床医生和公共卫生专家提供一个重要的新工具，用于启动某些预防性药物治疗方案（如结核病或肺孢子虫肺炎预防）或抗逆转录病毒药物。Midion Chidzonga，目前是一名由“艾滋病国际培训和研究计划”Fogarty资助的Fogarty培训生（2D 43 TW 00003 -11; PI：Art Reingold; UCSF津巴布韦口腔部分PI：Caroline Shiboski）正在津巴布韦艾滋病毒感染和非感染妇女中进行横断面研究，以估计口腔粘膜疾病的患病率与该人群中艾滋病毒血清状态的关系。我们与Chidzonga博士合作，在此提议进行一项纵向研究，扩大目前在津巴布韦妇女中进行的这一横断面研究。我们的目标是：1）估计口腔粘膜疾病的发病率与已知的HIV疾病进展的免疫学标志物（CD 4淋巴细胞计数）的关系; 2）评估撒哈拉以南非洲地区计划生育/妇科诊所中训练有素的护士通过目视检查口腔来检测口腔粘膜病变的灵敏度和特异性。为了实现这些目标，我们将每隔6个月对225名HIV阳性受试者进行随访口腔检查，这些受试者是从正在进行的父母队列研究中招募到我们的横断面研究中的。作为拟议研究的一部分，每名参与者将在3年内每隔6个月接受一次检查。

DESCRIPTION (provided by applicant): As part of the last competing renewal application of the parent program project P01-DE07946 (PI: John Greenspan), we sought to address emerging problems concerning the oral manifestations of HIV/AIDS. To date, our research has focused on HIV-infected populations in the US. However, we are proposing, as part of the present FIRCA application, to expand our study of the role and significance of oral manifestations of HIV infection to a setting that thus far has been understudied: sub-Saharan Africa. Because biologic assays to measure HIV disease progression are rarely accessible in sub-Saharan African countries due to prohibitive cost, other less expensive means of monitoring disease progression are needed. In US populations, visual inspection of the mouth and diagnosis of selected oral mucosal lesions have been found to be good predictors of HIV disease progression. If the predictive role of oral examination can be confirmed in sub-Saharan Africa, this would provide an important new tool for clinicians and public health specialists in this setting with respect to initiation of certain prophylactic drug regimens (such as tuberculosis or pneumocystis pneumonia prophylaxis) or anti-retrovirals. Midion Chidzonga, currently a Fogarty trainee supported by the "AIDS International Training and Research Program" Fogarty grant (2D43 TW00003-11; PI: Art Reingold; UCSF PI for the oral component in Zimbabwe: Caroline Shiboski) is conducting a cross-sectional study among HIV-infected and non-infected women in Zimbabwe to estimate oral mucosal disease prevalence in relation to HIV serostatus in this population. In collaboration with Dr. Chidzonga, we are hereby proposing to conduct a longitudinal study by expanding this ongoing cross-sectional study among Zimbabwean women. Our objectives are 1) to estimate oral mucosal disease incidence in relation to known immunologic marker of HIV disease progression (CD4 lymphocyte count); and 2) assess the sensitivity and specificity of detecting oral mucosal lesions by visual inspection of the mouth by trained nurses in a family planning/gynecology clinic in the sub-Saharan African setting. To address these objectives, we will conduct follow-up oral examinations at 6-month intervals on 225 HIV-positive participants who are being recruited into our cross-sectional study from an ongoing parent cohort study. Each participant would be seen at 6-month intervals over a 3-year period as part of the proposed study.