MACS/WIHS -CCS

摘要 感染艾滋病毒的男子和妇女中有近一半是生活在南方的少数种族/族裔。HIV感染 尽管有治疗方法，但这仍然是一个重大的公共卫生问题。这项建议的目的是 提高对艾滋病毒感染后果的认识，重点关注艾滋病毒相关的合并症， 作为多中心艾滋病队列研究（MACS）的临床研究中心（CRS）和女性研究中心参与研究。 机构间HIV研究（WIHS）联合队列研究（MACS/WIHS-CCS）。为了实现这一目标，迈阿密将 提供专门知识，领导CCS统一科学议程的重要组成部分，并制定议定书 和实验室支持方案和子研究，以及实施完整的CCS统一科学 施政纲要的演讲为了实现这一目标，我们将招募并跟踪500名艾滋病毒感染者或有艾滋病毒风险的男性和女性。 我们将在迈阿密招募大约250名反映艾滋病毒流行情况的男性，并跟踪发生性行为的男性 男性、双性恋男性和异性恋男性，包括黑人或西班牙裔男性， 少数民族比例。作为一个目前的南方WIHS网站，我们将继续跟踪149名妇女参加了 有艾滋病毒感染或有感染艾滋病毒风险的妇女，主要是反映迈阿密艾滋病毒流行的少数群体。与 CCS协议的可用性，我们将从社区招募额外的100名妇女，以达到 约250名女性。入组的男性和女性将符合研究方案的要求， MACS/WIHS联盟为新注册。迈阿密将继续其强有力的领导，因为我们提供了 WIHS。Fischl博士作为该多PI提案的主要PI是WIHS的副主席， 与同事们沿着，在制定统一的科学议程，包括具体目标方面发挥作用， 核心方案访视的频率，以及临床试验、标本采集、调查、评估和 临床试验迈阿密CRS将专注于几个创新领域的方案和子研究。探索 在HIV、烟草、兴奋剂使用和抑郁综合征中的心血管结局和HIV进展， 并研究心血管疾病风险和免疫激活的炎症生物标志物，包括性别 差异2.探索口腔，女性生殖器和肠道微生物组对HIV储库的影响， 接受抗逆转录病毒治疗3.评估合并症和HIV持续存在、炎症和 免疫标记物对合并症结局的影响以及炎症、淀粉样蛋白病理和先天性 免疫细胞表型对疾病结果的影响。4.检查漏洞和漏洞的轨迹 以及与艾滋病毒结局和合并症的关系，以及心理社会和行为 预测因素影响结果。5.研究心理社会因素和物质 使用可能会增加心血管疾病，损害神经认知功能，并有助于艾滋病毒的持久性。5. 利用发展基金支持早期和成熟的研究人员开发创新的试点项目 问题研究这些发现将有助于提高对艾滋病毒的认识，治疗艾滋病毒，并指导未来的研究。

ABSTRACT Nearly half the men and women with HIV infection are racial/ethnic minorities living in the South. HIV infection remains a major public health problem despite the availability of treatments. The purpose of this proposal is to advance the knowledge of the consequences of HIV infection, with a focus on HIV-related comorbidities, by participating as a Clinical Research Sites (CRS) of the Multi-Center AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) Combined Cohort Study (MACS/WIHS-CCS). To meet this goal, Miami will provide expertise to lead important components of the CCS unified science agenda with protocol development and laboratory support to protocols and sub studies, as well as implementing the full CCS unified science agenda. To accomplish this, we will enroll and follow 500 men and women with HIV infection or at risk for HIV. We will enroll approximately 250 men reflective of the HIV epidemic in Miami, and follow men who have sex with men, bisexual men, and heterosexual men including men who are black or Hispanic representing a large minority proportion. As a current Southern WIHS site we will continue to follow the 149 women enrolled in WIHS who have HIV infection or at risk for HIV and are largely minority reflecting the Miami HIV epidemic. With availability of the CCS protocol, we will enroll additional 100 women from the community to reach a goal of approximately 250 women. The men and women enrolled will be consistent with protocol requirements of the MACS/WIHS consortium for new enrollments. Miami will continue its strong leadership, as we provided for the WIHS. Dr. Fischl as lead PI for this multiple PI proposal is the Vice Chair of the WIHS and has had an active role, along with colleagues, in the development of the unified science agenda, including the specific aims, frequency of core protocol visits, and timing of clinical tests, specimen collections, surveys, assessments and clinical tests. The Miami CRS will focus on protocols and sub studies in several innovative areas.1. Explore cardiovascular outcomes and HIV progression in the syndemic of HIV, tobacco, stimulant use, and depression, and investigate inflammatory biomarkers of cardiovascular disease risk and immune activation, including sex differences. 2. Explore the effects of the oral, female genital, and gut microbiome on the HIV reservoir and on exposure to antiretroviral therapy. 3. Evaluate comorbidities and effect of HIV persistence, inflammation and immune markers on comorbidity outcomes and plasma markers of inflammation, amyloid pathology and innate immune cell phenotypes on disease outcomes. 4. Examine the trajectories of vulnerabilities and resiliencies and relationship to HIV outcomes and comorbidities, and mechanisms by which psychosocial and behavioral predictors affect outcomes. 5. Examine the biological pathway whereby psychosocial factors and substance use may increase cardiovascular disease, impair neurocognitive function and contribute to HIV persistence. 5. Utilize developmental funds to support early stage and established investigators to develop innovative pilot studies. These findings will lead to improved understanding of HIV, treatment of HIV and guide future research.