Specialized Neuroscience Research Program Neuroscience is one of the target areas for clinical and basic research development given the pre-existing strengths of programs such as the Institute of Neurobiology, the RCMI Clinical Research Center (CRC), and the Specialized Neuroscience Research Program (SNRP). One of the most important strategies of the CRC program has been the introduction of clinical investigators to basic science methods to enhance the competitiveness of clinical proposals. Thus, the objectives of the (SNRP) are consonant with institutional research initiatives leading toward the expansion of the MSC research platform in neuroscience The SNRP 2 provides the ideal instrument to strengthen and upgrade the level of research in neurosciences at our institution. This program is critically needed for the continued enhancement of our existing clinical and basic research infrastructure and for strengthening scientific collaborations of local scientists with NIH-funded researchers with skills and expertise otherwise not available in Puerto Rico. With the continued development of our Clinical and Basic Research Programs and of our existing research infrastructures, the SNRP is a critical Effect of the SNRP on Health and Research Training Importance of Established NeuroAIDS Hispanic Latino Cohort Neurological complications of HIV are becoming more evident with advances in the treatment and extended life expectancy of HIV-infected patients. The prevention of these neurological complications is highly significant in that many result in impairment of motor and/cognitive functions, thus requiring prolonged assisted care of the patients and further burden for them and their family. The high incidence in minorities worsens the outlook in our populations and at the same time underscores the importance of early study in affected minority populations. The development of original investigation at our institution into the mechanisms of neurologic manifestations of HIV is key to addressing this problem. Most of the HIV-related research at the UPR Medical Sciences Campus has been as part of multicenter clinical trials. A major goal of the SNRP NeuroAIDS Program is the establishment of translational research and collaborative groups of basic scientists and clinical neuroscience researchers at UPR. Unfortunately, there have been few clinicians here involved in applied basic research. This situation has resulted in an absence of exposure to this type of investigation among residents, fellows, and students, who mainly rotate through the clinical services. Students interested in basic/clinical research usually seek such experience outside Puerto Rico during their fellowship years, and many of them remain in research-intensive institutions on the mainland. The combined efforts of clinical and basic research described in the SNRP have opened new and unique possibilities for resident students and fellows to explore modern scientific methods that are applied to clinical problems. The SNRP NeuroAIDS Program represents the first opportunity in recent years to expose MSC physicians-in- training and graduate students to basic research applied to clinical problems. The mere presence (and uniqueness) of clinical neurologists with such expertise has dramatically improved the clinical and basic research environment in the MSC. The chairman of the Department of Neurology, Dr. JesusVelez-Borras, has given his full commitment to the introduction of neurology residents and fellows to research in the neurosciences through the NeuroAIDS Program. In 2001 MSC UPR was awarded a SNRP grant from NIH/NINDS to develop clinical research in the area of neurological and neurobehavioral complications of HIV infection, specifically in a Hispanic (Latino) population. During the award period two longitudinal cohorts were developed. One, directed by Dr. Carlos Luciano, was intended to evaluate sensory peripheral neuropathy in HIV infection with special emphasis on children/adolescents;the other, directed by Dr. Wojna and Dr. Melendez, was aimed at the evaluation of HIV cognitive impairment in women. This was the first initiative to study HIV neurological and neurobehavioral complications in Puerto Rico, which represents a minority population. This cohort is unique in that it consists of HIV-infected Hispanic children/adolescents and women patients who are followed longitudinally. This cohort serves as a model for other Spanish-speaking populations mainly from the Caribbean, where HIV is increasing exponentially. This cohort was characterized by normalizing diagnostic tools, sharing preliminary data, and overcoming cultural aspects related to the participation in clinical studies. Our team has normalized diagnostic tests such as the neuropsychological battery and has developed screening tests such as the HIV Dementia Scale (HDS) that are directly and specifically applied to the longitudinal cohort of Hispanic NeuroAIDS patients. Since this is an observational longitudinal cohort, it has """"""""real world"""""""" relevance. Our cohort represents a group of the HIV/AIDS population of Puerto Rico that is characterized by its low socioeconomic status, its dependence on the state and federal governments for health care needs, and its poor treatment adherence. It is, therefore, an excellent resource for clinical research trials. Since 2001, when we began recruiting patients, the peripheral neuropathy cohort headed by Dr. Luciano has recruited 29 HIV + children/adolescents with a retention rate of 86% and 82 HIV + adults with a retention rate of 63%. For the cognitive impairment group, Dr. Valerie Wonja has recruited 78 HIV + women and 38 one-to-one matching controls in age, education, and sociodemographic characteristics. This cohort has a retention rate of 78% for year one and 68% for year two. This is an extraordinary retention rate if we consider that a lumbar puncture is performed once a year. Our Program Evaluation Committee PAC made the following statement after their last site visit (Sept 05) to our Institution: """"""""The PAC is once again impressed by the development and continuation of the clinical cohorts and encourages their expansion and further utilization. Specifically, 28 children with HTV infection and 40 pediatric controls, plus 72 women and 34 controls deemed appropriate for the study have undergone baseline visits. Both cohorts have been followed for about 2 years. Given the complicated protocols that include nerve conduction studies and skin biopsies in the pediatric cohort, and neuropsychological testing and lumbar puncture in the female cohort, the retention rates of approximately 80% are laudable."""""""" Thus, one of the major objectives of the SNRP 2 is to maintain and expand the existing cohort, which represents a unique platform for the study of neurological impairments in HIV+Latinos.
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