Concept Proposal for the Case-Control Proposal
Concept Proposal for the Case-Control Proposal
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This study will evaluation certain characteristics related to ethnicity of persons who test HIV positive. These characteristics will help researchers predict which individuals will develop full blown AIDS in general and which individuals will develop full blown AIDS more quickly. It seeks to answer the question: What difference does race play in the development of full blown AIDS in HIV positive persons?
AIDS has been a recognized pathology since the 1980s even though it has existed before that time. Though its origins and methods of obtaining it have been misunderstood, doctors now understand that the disease is passed along through bodily fluids, especially blood and semen. Persons at highest risk are those who engage in unprotected sex, those who use unsterilized needles, and children who are born from infected mothers.
Currently, AIDS rages most unchecked in countries with the poorest levels of education and health services, such as Africa. However, nearly all countries have cases of AIDS and must deal with the heavy medical and personal consequences of this incurable disease (See Figure 1).
The first acknowledgment of this disease surfaced in 1981 when a rare lung infection called Pneumosystis carinii appeared in gay men in large, urban cities such as New York. Simultaneously, a rare tumor known as Kaposi’s sarcoma was also reported in the same population. In 1986, the name of these widespread infections and tumors become known as HIV.
HIV stands for Human Immunodeficiency virus, and AIDS stands for Acquired Immunodeficiency Syndrome. HIV is generally believed to cause the disease, AIDS, which seriously depletes the body’s ability to fight off disease. The HIV virus attacks specific cells in the body known as lymphocytes (or T-cells). These cells are damaged by the virus and the cycle is perpetuated. As the T-cell counts drop in HIV infected people, the body becomes less and less able to fight of diseases that healthy people can easily thwart.
When the immune system becomes so weak that it becomes life-threatening, a person is considered to have AIDS. All people with AIDS have or had HIV, but not all people with HIV will develop AIDS - Concept Proposal for the Case-Control Proposal introduction. Complicating matters is the fact that a person with HIV may appear healthy form many years without any signs of illness at all. They might not know how sick they really are.
The Center for Disease Control has defined AIDS by a lost of infections, cancers, weight loss, dementia and a T-cell count of less than 200 cells per unit. They call AIDS a syndrome because not all individuals show the same symptoms, but generally, the body is weakened to a degree that opportunistic infections such as tuberculosis and pneumonia can easily infect it.
For the purpose of our study, HIV positive will be defined as the presence of HIV antibodies in the bloodstream at first testing and at a six-month retest. This six month period is recommend by doctors to confirm that the antibodies are indeed present, or that they have not been masked by any other coexisting symptom or illness. Full blown AIDS will be diagnosed using the Center for Disease Control criteria, especially as having fewer than 200 T-cells per unit of blood.
CASE STUDY DESIGN
This case seeks to discover the relationship between race and the time it takes an individual to progress from HIV to full-blown AIDS. The group of interest would be individuals that have first tested positive for HIV within a given period of time. We will take their histories and demographical statistics and chart their health over time to discover when and if they develop AIDS.
While, we are seeking to uncover whether race is a factor, but we may also discover other intervening factors such as medical history, genetics, other illnesses, age, income level, geographic location, sexual preference and gender, to name a few.
The sample groups we will study will be whites, African-Americans, Hispanics, Asians, Native Americans including Alaskans and Pacific Islanders.
Individuals will be asked to take part in the study on a voluntary basis. Participants will be sought at fifteen HIV testing sites across the United States. Only participants that test positive for the first time will be considered for the study to ensure that the time line for all participants is close to being the same.
The participants will be given a survey with comprehensive demographical information (such as the items listed above) so that intervening variables can be assessed. The participants will be required to have medical assessments at least yearly and will be followed up via phone, email or post and asked to submit medical information pertaining to their HIV status. The time at which the participants reach AIDS diagnosis (per a medical practitioner) will be noted as the end time for that participant.
We hypothesize that different racial groups will develop full blown AIDS from HIV in significantly different time frames. From there we will seek to discover similarities in many other demographic areas as noted in the questionnaires and the medical histories as to reasons why some races are more susceptible to AIDS than others.
ANALYSIS and FUTURE STUDY
The results of the study will have wide-ranging effects on the medical community. First, with the extensive demographic information already published and with the demographic information we will collect, many factors can be compared among the racial groups (see Figures 2 and 3). For example, information would be available on each ethnicity with regard to HIV and AIDS. For example, research already indicates that African-American have a much higher rate than whites when it comes to becoming infected with HIV.
From this point, research can be suggested as to whether the influential factors that control this are income level, genetic factors, healthcare or other possibilities. While we will initially be making adjustments for all of these intervening factors in our study, the information could be vital for future studies. Biological comparisons could help doctors identify HIV patients who are at a higher risk and intervene medically perhaps before they may have in the first place.
One important area to research could be gender differences among and within races.
Similarly, there may be a scientific basis as to why there is a difference between the average time it males versus females to transition from HIV to AIDS. As we very well know, there are many biological differences between males and females that already account for different developments of many diseases, and there is no reason why this could not be the case with the development of HIV.
It is well known that AIDS is an equal-opportunity disease which depends heavily on the chosen behaviors of some individuals. However, it would certainly benefit research to discover if any racial or gender related factors influence the development and progression of the disease. Discovering ethnicity-related factors can point to either genetic or biological causes inherent I the race itself, or it may point to cultural or socio-economical factors consistent within that particular race. Either way, the knowledge will help doctors and researchers understand more about the patients and the disease and to intervene in a way that they may not have previously undertaken. Until a cure is found for this horrible disease, the more information available on the victims of this disease, the better.
FIGURE 1 – from the Center for Disease Control
Figure 2 – from the Center for Disease Control
Figure 3 from the Center for Disease Control