Mentored Scientist Award

In the United States, Latinos are disproportionately impacted by HIV and have high rates of substance use and depression. Untreated substance use and depression often co-occur and are driving poor engagement in HIV care and impeding efforts to eliminate health disparities and the reduction of new infections. This Mentored Scientist Award will support the conduct of original research in the area of substance use and depression fromthe CFAR Network of Integrated Clinical Systems (CNICS) cohort of HIV+ Latinos.

In the initial days to weeks after infection with HIV, viral RNA enters the central nervous system (CNS) and is thought to form reservoirs in brain tissue that, in the long term, contribute to HIV-associated neurocognitive disorder (HAND) in up to 50% of patients. As patients are usually diagnosed with HIV well after CNS reservoirs have formed, patients with acute HIV (e.g.

Tuberculosis (TB) is the leading cause of death among adults living with HIV in sub-Saharan Africa. Recent randomized clinical trial data has shown that earlier ART initiation (within two weeks for CD4 <50/µl and within two months for CD4 >50/µl) reduces mortality by 40 to 50%. There is a large gap, however, in the translation of this evidence into real world practice.

Malaria remains one of the most formidable infectious diseases worldwide, particularly in sub-Saharan Africa, where it overlaps with the HIV epidemic. For many people in highly endemic areas, malaria parasitemia is asymptomatic, however, parasitemia provides a reservoir of parasites that drives malaria transmission.

Antiretroviral (ARV) therapy has greatly reduced HIV-related mortality, but treated patients still display excess mortality compared to HIV-negative individuals. This mortality is mostly driven by "non-AIDS defining conditions" such as cardiovascular and hepatic disease as well as non-AIDS related malignancies.

Malaria during pregnancy commonly leads to placental malaria, with adherence of parasite-infected erythrocytes in the placenta, and high risk of adverse maternal and fetal outcomes. Risk factors for placental malaria are not well understood. Moreover, there is an urgent need to identify optimal methods of diagnosing placental malaria.

We recently reported the clinical and epidemiological characteristics of an atypical group of patients who developed Kaposi sarcoma (KS) in spite of having suppressed HIV and relatively higher CD4+ counts. Given similarities in clinical presentation between the KS of these long-term treated patients and the classical KS observed in HIV-- elderly, we postulated that immunosenescence may be causally associated with emergence of KS.

Publications:

• PubMed# 18945778
• PubMed# 19381272
• PubMed# 18362693
• PubMed# 19390417
• PubMed# 19265479
• PubMed# 19109229

Publications:

• PubMed# 19011423