International Mentored Scientist Award

Most HIV-infected subjects exhibit a progressive rise in CD4 T-cell counts after initiation of highly active antiretroviral therapy (HAART). However, a subset of individuals exhibit very poor CD4 T cell recovery despite effective control of viremia. Increased activation-induced programmed cell death of CD4 T cells has been proposed as a mechanism underlying poor immune recovery. We propose to perform a nested case control study utilizing a rural cohort of HIV-infected adults whose CD4 T-cell counts have remained low (<50 cell increase) despite HAART for at least six months.

Human papillomavirus (HPV) is associated with cervical, vulvar, anal and penile cancers. High incidence rates of these cancers are observed in Africa compared to other parts of the world. Severa studies have implicated that the sexual behavior of the male partner is or even more important than women?s personal sexual behavior in predicting her risk of HPV associated cancers. Little is known about the natural history of HPV infections among men; thus hampering efforts to control infection in both men and women.

There are more than 3 million children 15 years estimated to be living with HIV, with almost 90% residing in sub-Saharan Africa (SSA). This presents a growing challenge to health providers and caregivers concerning the disclosure of HIV serostatus to infected children. Studies conducted in SSA have indicated that only 2% to 37.8% of HIV-infected children 15 years know their HIV status. Despite formal recommendations for disclosure, there are no tested models for supporting caregivers and HIV-infected children in SSA through the process of disclosure.

Depression is a serious public health concern, due to its negative impact of women's health, their infants and their families. HIV-infected caregivers are at high risk for a range of psychiatric and emotional problems that impact medication adherence and disease progression, and negatively affect mother-infant interactions, infant and child health, and development outcomes.

The Vδ2+ subset of γδ T cells possess intrinsic reactivity to malaria antigens and may be an important antimalarial effector mechanism, but there is evidence that chronic exposure to malaria and HIV is associated with the loss and dysfunction of this subset. It is unclear whether in utero exposure to malaria or HIV is associated with reduced frequencies and/or dysfunction of Vδ 2+ T cells.

In sub-Saharan Africa, screening and brief intervention (SBI) to reduce alcohol consumption may improve HIV treatment outcomes in HIV-infected hazardous drinkers. However, the feasibility, efficacy and effectiveness of this intervention in this region remains unknown. We propose to carry out a qualitative study to describe the feasibility of using SBI to reduce hazardous alcohol use in HIV infected adults in Uganda.