HIV-CNS Diseases and Parasitic Zoonoses in the Eastern Cape, South Africa

描述（由申请人提供）：这是对2006年首次提交给本项目的提案1R21NS059321的重新修订。为响应FOA的要求，该项目旨在发展南非东开普省（ECP）的本地研究能力，并为R01申请提供初步数据，以研究南非东开普省（ECP）寄生虫人畜共患感染和神经系统并发症与艾滋病毒感染和艾滋病的关系。在试点项目中，我们将重点关注神经囊虫病和脑弓形虫病作为感兴趣的寄生虫人畜共患病。该项目的具体目标是：1)加强和扩大来自公共卫生学院、美国俄克拉何马大学健康科学中心、沃尔特西苏鲁大学和南非东开普省姆塔塔纳尔逊曼德拉学术医院、寄生虫病司、美国疾病控制和预防中心国家人畜共患病、媒介传播和肠道疾病中心的研究人员之间的现有合作；圣基茨罗斯大学和东部和南部非洲囊虫病工作组（囊虫病工作组），并通过开展试点研究，提供流行病学研究方面的额外培训；2)开展先期研究，估计晚期HIV感染者（3期）、非晚期HIV感染者（1期和2期）和HIV阴性患者血清弓形虫病和囊虫病的患病率，每组进一步细分为有和无临床明显神经系统疾病的患者；3)利用这些前期研究数据估计HIV与神经囊虫病或神经弓形虫病在青少年和成人神经系统并发症发生中的相互作用。该项目的长期目标是开发基于多学科的干预措施，以更有效地控制可预防的寄生虫人畜共患感染，这种感染可能对艾滋病毒/艾滋病感染者造成不成比例的影响，并导致这一群体的神经系统并发症。该项目的初始阶段将包括加强美利坚合众国、南非以及东部和南部非洲若干国家（通过非洲疾病研究中心）的调查人员之间的现有合作，并评估该区域目前对影响中枢神经系统的寄生虫病，特别是神经囊虫病和脑弓形虫病的流行情况的了解情况。在南非东开普省的艾滋病毒/艾滋病感染者和艾滋病毒阴性人群中。在此阶段将为学生和同事确定培训机会。我们还将与美国国家医学协会和华盛顿州立大学合作，使它们的伦理委员会得到美国卫生与公众服务部（DHHS）人类研究保护办公室（OHRP）的认可。我们估计这一阶段需要6到9个月才能完成。在第二阶段，将进行一项试点研究，以估计晚期艾滋病毒感染者、非晚期艾滋病毒感染者和未感染艾滋病毒者的血清患病率，并测量神经系统并发症与猪带绦虫和犬弓形虫感染流行之间的横断面关联。公共卫生相关性：该项目将确定艾滋病毒感染者与人类和动物可携带的寄生虫相互作用时发生的过程。这项研究将在南非的东开普省进行，那里HIV和寄生虫感染都很常见。了解更多关于寄生虫感染/艾滋病毒相互作用的信息可以更好地预防艾滋病毒感染者的神经系统疾病。

DESCRIPTION (provided by applicant): This a re-revision of the proposal 1R21NS059321 first submitted to this program in 2006. In response to the requirements of the FOA, this project is intended to develop local research capacity in the Eastern Cape Province (ECP) of South Africa and to provide preliminary data in support of an R01 application to study the association of parasitic zoonotic infections and neurological complications with HIV infection and AIDS in the Eastern Cape Province (ECP) of South Africa. For the pilot project, we will focus on neurocysticercosis and cerebral toxocariasis as the parasitic zoonoses of interest. The specific aims of this project are to: 1) Strengthen and expand existing collaborations among investigators from the College of Public Health, University of Oklahoma Health Sciences Center in the USA, the Walter Sisulu University and the Nelson Mandela Academic Hospital in Mthatha, Eastern Cape, South Africa, the Division of Parasitic Diseases, National Center for Zoonotic, Vector-borne & Enteric Diseases at the Center for Disease Control and Prevention in the USA, Ross University in St-Kitts and the Cysticercosis Working Group in Eastern and Southern Africa (CWGESA), and through the conduct of the pilot study, provide additional training in epidemiologic research; 2) Conduct a pilot study to estimate the seroprevalence of toxocariasis and cysticercosis in six groups: patients with advanced HIV (stage 3), those who have non-advanced HIV infection (stages 1 and 2), and HIV negative patients, each group being further subdivided into those with and without clinically apparent neurological disorders; 3) Use these pilot study data to estimate the interaction between HIV and neurocysticercosis or neurological toxocariasis in the occurrence of neurological complications in adolescents and adults. The long-term goal of this project is to develop multidisciplinary-based interventions to more effectively control preventable parasitic zoonotic infections that may disproportionately affect people living with HIV/AIDS, contributing to neurological complications in this group. The initial phase of the project will consist of strengthening the existing collaborations among the investigators in the United States of America, South Africa and several countries of Eastern and Southern Africa (through the CWGESA), and evaluating the current state of knowledge in the region regarding the prevalences of parasitic zoonoses affecting the central nervous system in general, and neurocysticercosis and cerebral toxocariasis in particular, among people living with HIV/AIDS and in HIV-negative people in the Eastern Cape of South Africa. Training opportunities for students and colleagues will be identified during this phase. We will also work with the NMAH and the WSU to have their ethical board recognized by the Office for Human Research Protections (OHRP) of the United States Department of Health and Human Services (DHHS). We estimate that this phase will take between six and nine months to complete. In a second phase, a pilot study will be conducted to estimate seroprevalence and to measure the cross-sectional associations between neurological complications and prevalence of Taenia solium and Toxocara canis infections in persons with advanced HIV, with non-advanced HIV infection and those without HIV infection. PUBLIC HEALTH RELEVANCE: This project will identify processes that occur when people with HIV interact with parasites that both humans and animals can carry. The study will take place in the Eastern Cape Province in South Africa-where both HIV and parasitic infections are common. Learning more about the parasitic infection/HIV interaction could better prevent neurological disease in people with HIV.