As the HIV epidemic has matured, understanding the impact of HIV on overall health becomes more important as HIV is managed as a chronic illness. This is particularly true in the Southeastern part of the United States, where the epidemic is worsening relative to other parts of the country. 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 minorities. Barriers to access to care are among the worst in the US, and the prevalence of obesity, cardiovascular disease, cancer, and health care disparities are most pronounced. Therefore, studying people living with HIV in the Deep South will provide the opportunity to understand the current epidemic 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 many areas, including psychosocial/behavioral, neurocognition, aging, cancer, pathogenesis, and health disparities. UAB scientists have emerged as leaders in innovative cohort research that evaluates the long-term outcomes 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 subaward partner, we take full advantage of their years of expertise in HIV clinical care, outreach, and cohort research. Collectively, we represent an ideal cohort for the MACS/WIHS Combined Cohort Study (CCS), both in terms of scientific expertise and representation of the current HIV epidemic in the US. The Specific Aims for our CCS site are: 1. To continue to provide scientific leadership and expertise within the CCS, focusing on psychosocial/behavioral, structural and genetic determinants of HIV and co-morbidity-related outcomes; neurocognition among aging PLWH; and immunopathogenesis of HIV disease. 2. To collect high-quality data and specimens from MACS/WIHS-CCS core and sub-study visits to contribute to the Unified Scientific Agenda (USA) and protocols; and collaborate with the overall team of MACS/WIHS-CCS investigators across sites. 3. To continue to achieve operational excellence by maintaining outstanding records for recruitment, retention, data quality and completeness and cost-effectiveness. 4. To ensure sharing of data/specimens with the data center, the NIH community and external investigators, and communication/engagement with local communities. 5. To develop, mentor and support junior and minority investigators in coordination with Developmental Award Advisory Committee (DARC). 6. To recruit and retain a cohort of 230 women and 270 men, HIV-positive and age-matched HIV- negative controls, who are strategically selected to enable the conduct of the USA.

Project Narrative As the HIV epidemic has matured, disproportionate high numbers of new infections are continuing to occur in the Southeastern US. UAB and UMMC 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 UAB/UMMC site will significantly contribute to the knowledge and scientific evidence base aiming to understand the impact of HIV on men and women living with HIV.