This Career Development Award application describes an integrated training and research program for Michael Silverberg, Ph.D., MPH designed to provide expertise in the topic of cancers in an aging HIV-infected population. Dr. Silverberg's interests in the viral etiology of cancers, focusing on human papillomavirus, as well as the benefits and consequences of long-term highly-active antiretroviral therapy (HAART) use, have shaped his commitment to the study of cancers in HIV patients, which account for one-third of deaths in this group. Three retrospective cohort studies are proposed using laboratory, pharmacy and clinical databases of Kaiser Permanente, and include 18,000 HIV-infected and 180,000 HIV-uninfected persons followed from 1996 to 2006. These research projects aim to: 1) compare cancer incidence by HIV status and HAART use;2) compare cancer progression by HIV status and HAART use;and, 3) identify adverse events associated with concomitant HAART use and cancer therapy. Study strengths include the large size, individual data on HAART and traditional cancer risk and prognostic factors, stable and extended follow-up, precise linking of disease registries, and inclusion of HIV-uninfected controls. Career goals that will be achieved during the award period are: 1) acquiring expertise in cancer epidemiology and biology;2) attaining proficiency in advanced biostatistical methods;3) obtaining knowledge of clinical management of HIV and cancer;and 4) developing academic and professional skills. The tradition of outcomes-oriented research at the Division of Research at Kaiser Permanente, supplemented by the resources at several academic institutions provide the ideal environments to achieve these goals. A strong team of mentors has been assembled to provide diverse expertise in cancer etiology, epidemiology, biostatistics and clinical care. These skills are essential for the multidisciplinary environment of Kaiser Permanente. Career goals will also be met through coursework, directed reading, focused biostatistics training, clinic observations, attendance at conferences and workshops, and through research. It is not known why cancer risk is increased among HIV-infected patients or why prognosis is often worse. It is also not known which cancers are affected by long-term HAART use or if simultaneous HAART use and cancer therapy is associated with side effects. The results of this research may be informative to those providing care to HIV-infected patients with or at-risk for cancer.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Scientist Development Award - Research & Training (K01)
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Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Sharp, Gerald B
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Kaiser Foundation Research Institute
United States
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Anderegg, Nanina; Johnson, Leigh F; Zaniewski, Elizabeth et al. (2017) All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: correcting for loss to follow-up. AIDS 31 Suppl 1:S31-S40
Park, Lesley S; Hernández-Ramírez, Raúl U; Silverberg, Michael J et al. (2016) Prevalence of non-HIV cancer risk factors in persons living with HIV/AIDS: a meta-analysis. AIDS 30:273-91
Marcus, Julia L; Chao, Chun; Leyden, Wendy A et al. (2015) Survival among HIV-infected and HIV-uninfected individuals with common non-AIDS-defining cancers. Cancer Epidemiol Biomarkers Prev 24:1167-73
Park, Ina U; Wojtal, Nicole; Silverberg, Michael J et al. (2015) Cytology and human papillomavirus co-test results preceding incident high-grade cervical intraepithelial neoplasia. PLoS One 10:e0118938
Abraham, Alison G; Althoff, Keri N; Jing, Yuezhou et al. (2015) End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis 60:941-9
IeDEA and ART Cohort Collaborations; Avila, Dorita; Althoff, Keri N et al. (2014) Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 65:e8-16
Samji, Hasina; Cescon, Angela; Hogg, Robert S et al. (2013) Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 8:e81355
Hanna, David B; Buchacz, Kate; Gebo, Kelly A et al. (2013) Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. PLoS One 8:e78952
Ralston, James D; Silverberg, Michael J; Grothaus, Louis et al. (2013) Use of web-based shared medical records among patients with HIV. Am J Manag Care 19:e114-24
Hanna, David B; Buchacz, Kate; Gebo, Kelly A et al. (2013) Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009. Clin Infect Dis 56:1174-82

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