Advances in antiretroviral therapy have reduced but not eliminated mortality and neurologic morbidity related to HIV infection. The epidemic has been transformed into a chronic disease in which there is a dynamic equilibrium between mechanisms maintaining viral persistence and host immune strategies that, in combination with antiretroviral therapy, hold viral activity in check. Prospects for eradication or cure are many years or decades away. Looking toward the future, the HNRC perceives four general areas in which research needs are greatest. In the renewal period, the Neuromedical Core (NMC) will therefore develop and mature its research infrastructure to support studies addressing the themes of aging, acute and early HIV infection and clinical relevance. A common thread linking these three themes is genetics-both host and viral. The newly-organized NMC is made up of two cooperative units comprising common resources (equipment, supplies) and staff that interact on a daily basis: a Clinical Research Support Unit (CRSU);and a Laboratory, Pharmacology &Biomarker Unit (LPBU). Together these units will perform evaluations on all HIV+ subjects and HIV- controls, including those enrolled in pilot studies of the Developmental Core. The over-arching objectives of the Neuromedical Core (NMC) are to provide comprehensive clinical and laboratory evaluations, scientific consultation, and mentorship, training, and community education in NeuroAIDS. In the current funding period the NMC facilitated 70 research projects including observational cohort studies, clinical-pathological investigations, imaging studies, clinical trials and international research performed by collaborating investigators at UCSD and many other institutions. By assisting investigators in widely diverging disciplines at all levels of project development, from conceptualization of hypotheses to study implementation, analysis, interpretation and dissemination, the NMC encourages the application of multiple scientific perspectives and stimulates interdisciplinary collaboration and coordination. Through a variety of flexible mechanisms including face-to-face meetings and video teleconferences we will collaborate closely with the Neuroimaging, Neurobehavioral, Neurovirology, Neurobiology, Developmental and International Cores to further the HNRC's transdisciplinary aims.

Public Health Relevance

Antiretroviral therapy has transformed the HIV epidemic in the US into a chronic, manageable disease, but prospects for eradication or cure are many years or decades away. As the population of surviving HIV+ individuals ages, public health priorities in neuroAIDS will increasingly shift towards dealing with diseases and disabilities resulting from the interaction of aging and HIV, including Alzheimer's disease and cerebrovascular disease.

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National Institute of Mental Health (NIMH)
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