The advent of low cost antiretroviral drugs has brought new hope for people living with HIV in Africa. With assistance from donor agencies, many African nations have begun to implement antiretroviral treatment programs to provide widespread access to therapy and comprehensive HIV care. In Kenya, one such model initiative has been established at Bomu Medical Center in Mombasa. The Bomu program offers a unique opportunity to undertake groundbreaking clinical research into the effects of antiretroviral treatment in Africa. This application proposes a collaboration between the NYU CFAR, and Bomu Clinic to study novel methods of therapeutic monitoring and to investigate changes in immune function over time in a partly-treated cohort of patients. Immunologic investigations will be conducted in two phases. Blood specimens will be stimulated with antigens in the field and then frozen and shipped in batches to New York for testing. Analyses will determine the number, function, and activation state of both T cells and dendritic cells, which are key determinants of HIV-immunity. These results will be correlated with clinical data such as treatment regimen, CD4 count, viral burden, disease progression and the presence of co-infection with intestinal parasites and TB. Virologic investigations will be performed within the laboratory of the NYU-affiliated AIDS Research and Family Care Clinic. Standard viral load assays will be compared with a sensitive enhanced p24 assay, which is more than ten times cheaper. Our findings could have a significant impact on the ways in which HIV infection is monitored and treated in Africa. An ultimate goal of this application is to engage researchers in Kenya and eventually transfer the research technology to build local capacity and resources. ? ?
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