The Study to help AIDS Research Effort (SHARE) studies the natural history of infection with human immuno deficiency virus, type 1 (HIV- 1). SHARE, along with similar sites in Chicago, Pittsburgh, and Los Angeles, forms the Multicenter AIDS Cohort Study (MACS). MACS participants, including 1447 enrolled in SHARE, have been followed semiannually since 1984 and have provided questionnaire data, physical exam data, laboratory data ( including HIV-1 serostatus and T - cell subset measurements), and a large repository of plasma, serum, cryopreserved peripheral blood mononuclear cells and other specimens. Evaluating and following the prevalent and incident cases of HIV-1 infection in the MACS including 584 in SHARE, has provided key insights into risk factor s for infection with HIV-1, progression of HIV-1 infection once it is established, host defense against HIV- 1, genetic factors affecting HIV-1 pathogenesis, and use and efficacy of different forms of therapy for HIV-1 infection and for opportunistic pathogens. SHARE and the MACS have made key contributions to defining the importance of the measurement of t- helper (CD4+) lymphocytes, plasma viral load, and immune activation as pathogenic and prognostic factors in HIV-1 infection. SHARE has also played a leading role in the MACS neuropsychological studies. The current project request the continuation of the follow up of the SHARE cohort from 1999 to 2003. Expected survival and enrollment of the HIV-1 infected cohort members through this time period is 89% Specific Aims of the renewal include defining the long-term efficacy and safety of newer highly active antiretroviral treatments (HAART) and new clinical outcomes associated with HAART - induced increases in survival (e.g, neurological and oncological diseases with long incubation periods); defining prognostic markers for people taking HAART; and following cohort members for full characterization of outcomes.
These aims can be addressed only with continued follow up of this extremely well-characterized cohort. Other studies that depend on such follow up, but will be carried out with collaborators rather than being directly addressed in this application, include virological and immunological mechanisms of HIV-1 pathogenesis, and laboratory correlates of disease progression or non-progression. The MACS should continue to play a leading role in studies designed to lead to better treatments and preventive vaccines for HIV-1 infection.
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