DESCRIPTION (provided by applicant): The goal of this application is to prepare the GHESKIO Centers in Port-au-Prince, Haiti for a multi-project CIPRA in five years. This goal will be achieved through the conduct of a randomized clinical trial of early versus delayed antiretroviral therapy for people with pre-AIDS symptomatic HIV disease and through research training and capacity building. The GHESKIO Centers, directed by Jean Pape, is a Haitian non-governmental research and training organization working in close partnership with the Haitian Government on HIV/AIDS. Over the next five years, GHESKIO will become a regional HIV/AIDS center providing training and conducting research in collaboration with partners in Haiti and the Caribbean. The specific aims are: Aim 1: To determine the optimal time to start antiretroviral therapy (ART). We propose to conduct a randomized clinical trial to determine the outcome of early versus delayed antiretroviral therapy (ART) in HIV infected adults with pre-AIDS symptomatic HIV disease (WHO Sate II or III symptoms, such as pulmonary TB, chronic diarrhea, or oral thrush) and a CD4 count between 200 and 350 cells/mm3. The primary hypothesis is: Early initiation of ART in HIV infected adults with pre-AIDS symptoms and a CD4 count between 200 and 350 cells/mm3 will improve survival at 36 months when compared to delaying ART until subjects develop clinical AIDS (WHO stage IV) or CD4 count <200 cells/mm3. Aim 2: To build on the existing capacity of the GHESKIO Center in Port au Prince Haiti and to prepare for a multi-project CIPRA within five years. Capacity will be increased in: 1) Administration, including development of an advisory council, increasing ethics capacity, strengthening grants management, and strengthening training. 2) Clinical investigation; 3) Data management and analysis; 4) Laboratory capacity including HIV virology and immunology. In each of these capacity building areas, we have identified promising young Haitians who will participate in the CIPRA project and who will also receive advanced training and mentorship by senior investigators from the US. These Haitians will be leaders in a multi-project CIPRA in five years.