North Carolina has already has already had substantial numbers of women and children detected with HIV disease. Several features of the HIV/AIDS epidemic predict a rapidly increasing problem with HIV disease in women and children: e.g., the percentages of reported AIDS cases in women and minorities are higher than the national averages and are growing, and the proportions of cases associated with IV drug use or heterosexual transmission are also disproportionately high. Also, epidemiologic data in our state suggest that about one-fourth of our AIDS causes may be associated with risk behaviors adopted during adolescence. Current ACTG data indicate that our pediatric component is one of the top enrollers of adolescents in ACTG trials; and it is in the top quarter of pediatric components of adult ACTUs, in total enrollment of children/adolescents into ACTG trials. Three areas of clinical focus have evolved: (a) provision of comprehensive services to referred HIV-exposed infants and their mothers; (2) optimal care for the many HIV-infected hemophiliacs in our Comprehensive Hemophilia Center, one of the nation's largest; and (3) establishment of a statewide adolescent outreach program, to provide HIV educational, preventive, and medical-referral services to HIV at-risk adolescents in our state. The primary goal of our pediatric component is provision of coordinated, state-of-the-art, comprehensive clinical care to these patient populations, in conjunction with their enrollment into ACTG studies. Ongoing clinical and basic research efforts are described herein. Support is requested for the clinical and ancillary services utilized in associated with ACTG activities.
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