) As survival has increased in patients with HIV infection, it is apparent that greater numbers of individuals are living long enough to eventually develop malignant disease. Further, with maturation of the AIDS epidemic, it appears that the spectrum of HIV associated diseases has expanded, with malignant diseases becoming more prominent as the cause of death in infected individuals. Aside from the current AIDS-defining malignancies, including Kaposi's sarcoma, lymphoma, and cervical cancer, additional types of cancers are now being reported in HIV infected individuals, with significantly increased standardized incidence ratios (SIRs) of anal cancer, Hodgkin's disease, lung cancer, multiple myeloma and others. In terms of public health policy, it is apparent from these data that the appropriate health care of our nation will require specific training of oncologist in the area of HIV disease. At the present time, there is no formalized mechanism to provide such cross-training, nor is there a mechanism to pay for such training. The goals of this Training Grant will be to train such individuals, who will then be prepared to treat HIV infected patients with malignant disease; to conduct research in this area; and, in time, to teach others these same skills.
The specific aims of the proposal are: (1) To provide comprehensive, multidisciplinary clinical training in HIV disease to individuals who have recently completed one or more years of formal fellowship training in Hematology'/Oncology; (2) To provide a didactic core curriculum, which will give a broad understanding of the advances in HIV disease, per se, as well as the opportunistic cancers, infections, and other illnesses which ensue; (3) To provide a didactic core curriculum, as well as practical, day-to-day training in the area of clinical research methods, to allow development of future clinical researchers in the area of AIDS-related malignancy; (4) To provide didactic training in the area of basic scientific research methods, to allow development of future clinical researchers who will understand the principles of translational research in the area of AIDS-malignancy; and (5) To provide close mentoring support from both clinical and basic scientific mentors, in order to assure that the candidates will engage in a specific translational research project related to the field of HIV-malignancies. We will offer a two-year Fellowship program. The first year will be spent in clinical work, with assignment of a specific clinical mentor to each Trainee. The year will consist of attendance at weekly general HIV/AIDS clinic; weekly AIDS/Lymphoma clinic; weekly AIDS/KS clinic; one month on in-patient HIV/AIDS ward; three months on inpatient AIDS malignancy ward; and attendance at didactic lectures and symposia. The second year will emphasize training in clinical and translational research in the area of AIDS-related malignancy, with assignment of specific scientific mentors, and development of research projects, as well as attendance at didactic lectures and symposia in the area of research methods and biologic principles.
