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DIVISION OF DISEASE PREVENTION

DIVISION OF DISEASE PREVENTION . Director Principal Investigator G Shor-Posner, PhD. EDUCATION J. LEWIS, PhD (Fogarty/Massage) Family Medicine. INTERNATIONAL T. BREWER, MD (Fogarty/Massage) CAP. FOGARTY ADMINISTRATOR P. O’DONOGHUE. RESEARCH COORDINATOR N. QUINTERO

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DIVISION OF DISEASE PREVENTION

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  1. DIVISION OF DISEASE PREVENTION Director Principal Investigator G Shor-Posner, PhD EDUCATION J. LEWIS, PhD (Fogarty/Massage) Family Medicine INTERNATIONAL T. BREWER, MD (Fogarty/Massage) CAP FOGARTY ADMINISTRATOR P. O’DONOGHUE RESEARCH COORDINATOR N. QUINTERO RESEARCH ASSOCIATE (Fogarty/Massage) LABORATORY VOLUNTEER A. Posner, PhD WORKSHOP COORDINATOR R. DIAZ SR. STAFF ASSOCIATE (Fogarty/Massage) FOGARTY TRAINEES Brazil Colombia Dominican Republic Jamaica Peru CONSULTANTS G. Moreno-Black, PhD G. Zhang, MD

  2. Eating Disorders – Anorexia, Bulimia, Obesity

  3. SLIM Disease

  4. Role of Micronutrients • Immune Processes • Antioxidant Defense • Brain Function

  5. Prevalence of SpecificNutrient Deficiencies Beach et al. AIDS 1992;6:701. Baum et al. IX Intl Conf AIDS, Berlin, 1994;1020. Bologna et al. J Nutr Immun 1994;3:41-48.

  6. COBALAMIN STATUS & BRAIN FUNCTION • NEUROLOGICAL COMPLICATIONS Subacute degeneration of the spinal cord, optic nerves, cerebral white matter, and peripheral nerves • PSYCHOLOGICAL SYMPTOMS Apathy, irritability, depression, confusion, dementia

  7. MICRONUTRIENT ANTIOXIDANT PROTECTION SCAVENGERS -tocopherol, ascorbic acid, -carotene ENZYME DEFENSE SYSTEMS Selenium, Zinc, Copper, Manganese, Iron

  8. Specific Nutritional Deficiency and HIV-Related Mortality Baum et al. JAIDS 1997.

  9. e Selenium Antioxidant - Se-GPx Essential Trace Element Neuroprotection Immune Function

  10. Selenium Therapy Trial • 259 HIV+ Drug Users • 200 g/day Selenium OR Placebo NIDA

  11. Selenium Therapy Trial Findings Se-Treated vs. Placebo Mycobacterial infections Hospitalizations Anxiety Quality of life (health) Shor-Posner et al. JAIDS 2002.

  12. Selenium Neuroprotection Trial • 115 HIV+ Drug Users • 200 g/day Selenium OR Placebo • One Year NIDA

  13. Findings from the Selenium Trial * * Group % S P S P S P S P BaselineOne YearBaselineOne Year State Anxiety Trait Anxiety >35 >35 Shor-Posner et al. Intl J Psychiatr in Med 2003.

  14. ARV

  15. HIV Wasting in the HAART Era Lipodystrophy –HIV-Related Adipose Redistribution FAT LOSS Limbs Buttocks Face

  16. HIV Wasting in the HAART Era Lipodystrophy – HIV-Related Adipose Redistribution FAT ACCUMULATIONWaist Breasts Face (Neck) INTERSCAPULAR FAT PAD -“Buffalo Hump”

  17. Nutrition in the HAART EraPharmacotherapy Challenges • Potential Interactions with Food • Body Metabolism • Side Effects

  18. HIV/AIDS ERA OF HAART 55% CAM USE Coleburdaset et al. Intl J STD & AIDS 2003;14:672-4. deVisser & Grierson. AIDS Care 2002;14:599-606 Hsiad et al. JAIDS 2003;33:157-165.

  19. NCCAM MAJOR TYPES OF CAM • ALTERNATIVE MEDICAL SYSTEMS • Homeopathic Medicine, Ayurveda • MIND-BODY INTERVENTIONS • Prayer, Meditation, Art, Dance, Music

  20. MAJOR TYPES OF CAM, cont… • BIOLOGICALLY BASED THERAPIES • Herbs, Foods, Vitamins • MANIPULATIVE & BODY-BASED METHODS • Massage, Chiropractic • ENERGY THERAPIES • Reiki, Magnetic Fields

  21. REASONS FOR CAM USE IN HIV/AIDS Still NO Cure, NO Vaccine HIV-Related Problems • Nausea, Depression, Insomnia, Weakness Sparger et al. J Altern Complement Med 2000;6:415-22.

  22. REASONS FOR CAM USE IN HIV/AIDS • Regain Sense of Control • Energy • Maintain Well-Being • Side effects of ARV drugs

  23. UMIAMI – Touch Research Institute (1992) First Center in the world devoted solely to the study of touch and its application in science and medicine

  24. MASSAGE Universal Instinct Touch is beneficial Touch – integral part of primate social system

  25. TRI MASSAGE STUDIES IN HIV • Gay Men (n=29, 20 HIV+, 9 HIV-)1 Massage vs Within-Subjects Control Group (daily for 1 month) NK cell number NK cell cytotoxicity Soluble CD8 No changes in CD4, -2, Neopterin Ironson et al. Intern J Neurosci 1996;84;205-17.

  26. TRI MASSAGE STUDIES IN HIV • HIV in Adolescents (n=24)1 Massage vs Muscle Relaxation (2x/week for 12 weeks) NK cell number (CD56) CD4/CD8 Ratio CD4 Number Diego et al. Int J Neurosci 2001;106:35-45.

  27. MASSAGE AND HIV+ CHILDREN • NO studies in young children • NCCAM – “Massage to Enhance Well-Being in HIV+ Dominican Children”

  28. STUDY DESIGN – Clinical Trial • Consented, HIV+ Children (n=54) • Ages 2-8 yrs. • Randomized • Massage • 2x/week, 20 minutes for 12 weeks • Friendly Visit (Reading/Drawing) • 2x/week for 12 weeks CENISMI – Robert Reid Cabral Children’s Hospital

  29. STUDY OUTCOMES ACCEPTANCE COMPLIANCE DEVELOPMENT IMMUNE FUNCTION

  30. IMMUNE PARAMETERS – PRE-POST INTERVENTION

  31. FINDINGS Mean CD4 Cell Count Massage Controls • Relative risk of having >20% decrease in CD4 cell count higher in controls. • (RR=5.7, p=0.03)

  32. NIH/NCCAM 1RO1 AT02689 Title: Massage Benefits in HIV+ Children: Mechanisms of Action

  33. Fogarty International Training Program HIV/AIDS and TB 1988 - 2009

  34. 1913-1967 “because disease knows no boundaries – and “because we care”.

  35. PROGRAM OBJECTIVES • Develop scientific and technical infrastructures • Train cadre of scientists who can: • Guide their countries in developing HIV/AIDS programs; • Implement interventions to reduce the burden of disease.

  36. MILESTONES • Training: 280 scholars from 26 different countries in Latin America and Caribbean; • Development of effective scientific infrastructures for biomedical research in Brazil, Colombia, the Dominican Republic and Peru.

  37. CHALLENGES OF INTERNATIONAL RESEARCH HIV/AIDS IN LATIN AMERICA Highly Diverse Parallel Epidemic of TB Access to Care Stigma and Discrimination ART

  38. THE NEEDS OF MOTHERS Do not stop with childbirth Challenges • Parenting (PMTCT-PLUS) • Optimal feeding practices • Coping with HIV

  39. OPTIMAL TREATMENT AND MANAGEMENT OF HIV/AIDS ANTIRETROVIRAL THERAPIES *ACCESS *ADHERENCE *EFFECTIVENESS

  40. MILESTONES Achievements of independent research funding by Trainees: • Global Fund • NIH / CIPRA / GRIP • World Bank • Elizabeth Glaser • UNICEF • CAREC

  41. Dr. R DeSouza • Dr. J Sampaio • Dr. G Malaquias • C Bisol

  42. Dr. B Acosta • Dr. X Burbano • Dr. J Galindo • Dr. AM Granada-Copete • Dr. H Rincon

  43. J. BAEZ, M.D. R. CASTILLO, M.S. W. DUKE, M.D. R. MENDOZA, M.S. M. MIRIC, M.S. E. PEREZ-THEN, M.D. N. SALCEDO S. SOTO, M.D.

  44. Fogarty HIV/AIDS Workshops Treatment Strategies PMTCT – Adherence; Stigma Reduction

  45. CLINICAL A.G. HOLLEY HOSPITAL, LANTANA, FL

  46. WORKSHOP “Meeting the Challenges of Research and Interventions for HIV/AIDS in International Venues”

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