Pilot Award

There is a fundamental lack of knowledge in identifying HIV infected individuals at high risk of fracture, and determining the effectiveness of treatment. Osteoporosis is usually diagnosed using DXA that provides an estimate of areal bone mineral density (BMD) computed for skeleton sites prone to fracture such as the femoral neck and the lumbar vertebrae.

HIV infection can result in a breakdown in intestinal immunity associated with the translocation of immunostimulatory microbial products from the gut lumen to systemic circulation, which initiates and sustains the persistent inflammation that drives progression to AIDS ¹ . In particular, we and others have shown that HIV infection induces a significant loss of IL-17-producing cells, including TH17 cells, that are critical for maintaining the mucosal barrier ^2,3 .

HIV infection can result in a breakdown in intestinal immunity associated with the translocation of immunostimulatory microbial products from the gut lumen to systemic circulation, which initiates and sustains the persistent inflammation that drives progression to AIDS ¹ . In particular, we and others have shown that HIV infection induces a significant loss of IL-17-producing cells, including TH17 cells, that are critical for maintaining the mucosal barrier ^2,3 .

A point-of-care (POC) test that could be implemented at peripheral levels of the health system in low-income countries has been predicted to reduce tuberculosis (TB)-related mortality by one-third. However, no truly POC test is in the diagnostic pipeline. For maximum impact, a POC test should have high specificity such that a positive test result can be followed by the immediate initiation of treatment. However, a highly sensitive but less specific POC test is a more realistic short-term goal and could be used as an important screening tool in peripheral health care settings ?

A point-of-care (POC) test that could be implemented at peripheral levels of the health system in low-income countries has been predicted to reduce tuberculosis (TB)-related mortality by one-third. However, no truly POC test is in the diagnostic pipeline. For maximum impact, a POC test should have high specificity such that a positive test result can be followed by the immediate initiation of treatment. However, a highly sensitive but less specific POC test is a more realistic short-term goal and could be used as an important screening tool in peripheral health care settings ?

Remarkable advances have helped to determine how immune responses act to contain HIV-1 infection, but precise immune correlates of protection still remain largely uncharacterized. The HLA region is a major determinant of genetics linked to viral control. HLA-B*57+ individuals are known to progress slowly to disease, and this allele is overrepresented in elite controllers. My preliminary results show a reduced replicative capacity of HIV-1 in PBMC from seronegative HLA-B*57+ subjects, in comparison to PBMC from subjects carrying HLA-B*35, an allele associated with rapid disease progression.

Remarkable advances have helped to determine how immune responses act to contain HIV-1 infection, but precise immune correlates of protection still remain largely uncharacterized. The HLA region is a major determinant of genetics linked to viral control. HLA-B*57+ individuals are known to progress slowly to disease, and this allele is overrepresented in elite controllers. My preliminary results show a reduced replicative capacity of HIV-1 in PBMC from seronegative HLA-B*57+ subjects, in comparison to PBMC from subjects carrying HLA-B*35, an allele associated with rapid disease progression.

A key challenge of large-scale intervention trials is to adequately describe the social, cultural and operational factors that influence study findings. Qualitative research methods are particularly useful for elucidating the processes through which such trials may affect primary clinical outcomes through social and behavioral change at the community level. This pilot award would launch the qualitative evaluation of a large "test and treat" intervention, the Sustainable East Africa Research in Community Health (SEARCH) trial.

A key challenge of large-scale intervention trials is to adequately describe the social, cultural and operational factors that influence study findings. Qualitative research methods are particularly useful for elucidating the processes through which such trials may affect primary clinical outcomes through social and behavioral change at the community level. This pilot award would launch the qualitative evaluation of a large "test and treat" intervention, the Sustainable East Africa Research in Community Health (SEARCH) trial.

As the prevalence of metabolic syndrome and obesity rises, and as more effective HCV treatments become available, fatty liver disease will likely become a leading cause of liver disease in persons living with HIV. The purpose of this study is to determine the association of metabolic, host genetic, and viral factors with hepatic steatosis (Aim 1) and hepatic fibrosis (Aim 2) in HIV-infected adults with and without HCV coinfection.