HIV-1 infected patients develop a number of neoplasms at strikingly increased rates compared to seronegative populations. These tumors, including non-Hodgkin s lymphoma (AIDS-NHL) and Kaposi's sarcoma (KS), are an important cause of morbidity and mortality in AIDS. Responses to cytotoxic chemotherapy are common, but these patients often experience more toxicity, higher rates of opportunistic infection, and poorer responses to treatment than uninfected populations. Therefore, novel treatment strategies are urgently needed, and a multicenter collaborative group for the study of these conditions, with a strong, creative laboratory base with experience in translational application as well as a sizable cohort of eligible patients, is critical to this effort. The University of California-San Diego (UCSD) Medical Center is ideal for these purposes. Between the Owen Clinic of UCSD, the Veterans Administration Medical Center, and the UCSD Treatment Center (all directly associated with UCSD) as well as the affiliate sites at the San Diego Kaiser Permanente Medical Center, Balboa Naval Medical Center, and Palm Springs, CA-based Desert Specialty Group, nearly 3800 HIV infected patients are included in this potential cachement. This accounts for nearly all of the patients with HIV-associate malignancies in the greater San Diego area. In the Owen Clinic (where most clinical studies would be performed), the facilities include physicians, nurse practitioners and physician assistants, nurses and other clinical personnel experienced in the care of HIV-positive patients, research pharmacists, a detailed medical database system with data analysis and entry personnel, and the adjacent Medical Center hospital facility with dedicated AIDS and medical oncology wars. The UCSD Cancer Center, consisting of 171 members in 18 departments of the University, has a significant clinical as well as experimental foundation. Scientific interests range from pathogenesis and treatment of KS and HIV infection to lymphomagenesis to gene therapy; many of these researchers are collaborators on this proposal. Of special interest is the Program in Human Gene Therapy, a multidisciplinary project for the rapid development of vectors and constructs for clinical trial. These resources from many areas of UCSD and outside have been made available for integration into the resources of the Consortium.
