DESCRIPTION (provided by applicant): The WIHS is the largest and longest-duration cohort study of HIV infection in women in the U.S. The San Francisco Bay Area WIHS (SF WIHS) application is focused on continuing our contributions to WIHS: 1. Enrollment and retention of participants (including HIV+ women who are not in care) via a regional consortium and generation of complete and high quality data and specimens, 2. The vigorous participation of site investigators in the WIHS scientific process, and 3. Proposal of new aims that address key issues concerning processes and conditions associated with excess morbidity in HIV+ women in the current treatment era. The new aims feature special emphasis on vascular injury and pain and were selected because they concern key morbidities in potent antiretroviral therapy (cART) treated women, involve sex dimorphic phenomena, and may be influenced by gonadal aging. Vascular measures include indicators of medium (Ankle Brachial Index) and very small vessel condition (measures of retinal vessel caliber). We put forward an increased focus on functional outcomes, including specific organ functional measures, and total physical fitness and morphology (such as kyphosis). The pain studies take the unique approach of assessing what participants mean when they report pain, assess genetic contributions and examine outcomes that include physical function. We also propose to continue our work to measure long term exposure to antiretroviral drugs (ARVs) using hair samples, which are producing high impact reports concerning the pharmacology of ARVs in women and continuation of the WIHS Genetics Unit that was recently established in SF WIHS and is conducting Genome-Wide Association Studies.

PUBLIC HEALTH RELEVANCE: The WIHS is the largest United States study of HIV, the virus that causes AIDS, in women. Even now, when good treatments are available for HIV, women living with HIV have more health problems and an increased chance of death, than women without HIV. Research is needed to better understand why HIV medicines do not eliminate the problems of poor health among women living with HIV infection. This grant application proposes continuation of the San Francisco WIHS site (SF WIHS). Our WIHS site has performed very well in terms of enrolling women and retaining them in the study. We also support many of the scientific leaders in WIHS. Besides continuing the WIHS core study, we propose new studies that will examine injury to blood vessels (including studies of the eye), hormonal conditions, how tenofovir levels affect the kidneys and bones, and we will study chronic pain in women living with HIV.