As the AIDS epidemic has matured a disproportionate number of new infections are occurring in the Southeastern US. As such, the Women's Interagency HIV Study (WIHS) cohort is expanding to include a new site in the Southeast to make the cohort more representative. Alabama and Mississippi are located in the heart of the Deep South and have some of the highest rates of new HIV cases annually, especially among minority women. Barriers to access to care are among the worst in the US, and the prevalence of obesity, cardiovascular disease, cancer, and health care disparities most pronounced. Therefore, establishing a new WIHS site in this area of the country will provide the opportunity to assess the 'new' epidemic of AIDS as it is emerging today. The University of Alabama at Birmingham (UAB) has a rich tradition of AIDS research, dating back to the mid-1980s. As the epidemic has matured, UAB scientists have established expertise in the socio-behavioral factors that propagate the epidemic, including barriers to testing, linkage to care, retention in care, and stigma. UAB scientists have emerged as leaders in innovative cohort research that evaluate the long term outcomes and comparative effectiveness of regimens via multisite cohort studies (e.g., CNICS, NA-ACCORD, ART-CC, and FRAM). By creating a linkage to the University of Mississippi Medical Center (UMMC) as a subunit partner, we take full advantage of their years of expertise in HIV clinical care, outreach, and cohort research. Collectively, we represent an ideal addition for WIHS both in terms of scientific expertise and representation of the current HIV epidemic in the US.
The Specific Aims for our new WIHS site are: 1. To assess psychosocial barriers to HIV prevention behaviors, testing, linkage to care, and retention in care among recently diagnosed women in the Deep South. 2. To evaluate the influence of hormonal contraception and body fat mass on immune hyperactivation and accelerated immunosenescence in HIV-1 infected women. 3. To determine the interplay between co-existing HPV subspecies and the vaginal microbiome in creating conditions favorable to the expression of cervical dysplasia and malignancy 4. To explore changes in the gut microbiome ('dysbiosis') occurring as a consequence of chronic HIV infection and its treatment. 5. To elucidate nutritional, host genetic, metabolic, and cultural factors that are contributing to the rapid emergence of obesity as a highly prevalent condition among HIV infected women 6. To recruit and retain a cohort of 300 women, half of whom are HIV seropositive and half well-matched HIV-negative controls, who are strategically selected to enable the conduct of the research projects proposed above while simultaneously meeting the needs of the WIHS cohort.
As the AIDS epidemic has matured a disproportionate number of new infections are occurring in the Southeastern US. UAB and the University of Mississippi have a rich history of HIV / AIDS research and patient care and are uniquely positioned to study the most contemporary scientific questions emerging over the next decade. As such, the establishment of the UAB-MISS WIHS cohort site in the heart of the Deep South represents an ideal addition to the national WIHS cohort.
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