The annual incidence of AIDS in Puerto Rico reached 1,229 in 1988; about 80% of which were associated with intravenous drug users (IVDUs). It is estimated that between 30,000 and 100,000 residents are already infected by HIV. In addition, IVDUs are frequently infected simultaneously by HTLV-I. Such dually infected individuals usually present an extremely aggressive form of AIDS. Most Puerto Rican AIDS patients are treated as outpatients due to the lack of AIDS beds. No anti-retroviral therapy such as AZT is currently available to most of them; a majority of whom are medically indigent. Therefore, no treatment is provided for as asymptomatic HIV (+) individuals and no attempt has been made to research out to these individuals. The Ponce School of Medicine RCMI program proposes to develop a community based AIDS Infrastructure program in order to expand our existing basic and clinical AIDS research capability. More specifically, we propose to institute an up-to-date diagnostic immunology program for the HIV affected population, so that we will be able to reach out to those who are currently under-represented (e.g., women at risk, IVDUs, and particularly those of lower income groups), who would otherwise not seek medica; attention. We plan to develop a coordinated counseling program which closely reflect the family and social structures, as well as moral and ethical values of the community. Clinical AIDS programs including provision of urgently needed anti-retroviral therapy, through both an RFP (RFP-NIH-NIAID-AIDSP-89-11) and a community HIV Service Program, as are discussed in the text. Through such an improved AIDS research infrastructure provided by RCMI program, we will investigate how wide and deep into society HIV infection has spread, how different the Puerto Rican AIDS cases are from the typical US form, as well as the efficacy of a therapeutic regimen against such different forms of AIDS, etc. Cellular as well as molecular mechanisms of immune impairment by HIV and possible improvement by therapeutic drug will also be addressed. In addition, a study will be initiated to investigate a possible genetic deviation of HIV strains in Puerto Rican from those isolated in the continental USA.
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