It is proposed to establish a Texas regional AIDS brain repository to elucidate mechanisms underlying the neuropsychological problems of AIDS patients. We will collect and maintain frozen human brain specimens from AIDS patients followed in the three largest community-based AIDS clinics in Texas located in Galveston, Houston, and Dallas. The hub of the Texas network will be based at the University of Texas Medical Branch at Galveston, where a comprehensive AIDS treatment center follows 3,000 HIV-infected subjects. Special features of the Galveston hub site are: 1) an autopsy service that has performed over 600 autopsies of AIDS patients; 2) a pre-existing AIDS brain repository containing over 450 saved brain specimens; 3) resources and experts from the adult AIDS Clinical Trial Unit will participate actively; 4) there is a large population of prison inmates allowing us to address health issues in this subgroup of AIDS patients. In neighboring Houston, 4,500 HIV-1 infected patients are followed in a community AIDS clinic staffed by physicians from Baylor College of Medicine and The University of Texas Health Sciences Center at Houston. The Galveston/Houston clinics combined follow 7,500 HIV-infected subjects in a geographically concentrated area of Texas. Infrastructures of these community-based clinics include social and family service networks that track end-stage AIDS patients and provide continuous services in terminal care settings. Another AIDS clinic that follows 2,900 patients is centered around UT Southwestern and Parkland Hospital in Dallas. Each Texas clinic module will field a team of investigators with demonstrated concerns for the welfare of AIDS patients. They will use uniform protocols to enroll end-stage patients into the study and perform formal neuropsychiatric tests, document substance abuse histories, and enter clinical and laboratory information into a secure database. Team members will follow patients into their communities and obtain a timely autopsy. The Galveston hub will provide core services including: 1) quality specimen banking facilities; 2) the PI's established AIDS brain repository; 3) a user-friendly and secure data storage and retrieval plan; 4) a centralized autopsy facility with a far-reaching transportation network. Our network will combine vast resources of large community clinic modules in Texas with the unique assets of the hub site to produce a durable, efficient, and renewable national resource to elucidate the neuropsychiatric problems of HIV infection.
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