The Reporter: Dec 1994, Vol.5, No.4
Research Notes

AIDS Prevention

Dr. Maria J. Wawer, associate clinical professor of public health and director of the International Operations Research Program at Columbia's Center for Population and Family Health, has received a grant from the National Institutes of Health/NIAID to conduct a prospective community-based intervention to determine whether intensive control of sexually transmitted diseases (STDs) will result in reduced HIV transmission. The study will be conducted in collaboration with the Ugandan Ministry of Health in Rakai District, an underserviced region of Uganda, where Dr. Wawer and her Ugandan co-investigators have documented high rates of both sexually transmitted diseases and HIV-1.

The study has two goals-to determine if eliminating STDs results in reduced HIV transmission and to evaluate the effectiveness of a modified mass treatment approach in controlling STDs. The study design is that of a community-based trial with treatment and control arms, each consisting of approximately 30 randomly assigned villages. In the mass treatment arm, all adults ages 15 to 59, symptomatic or not, will be offered a single, oral dose treatment twice a year for key STDs, with injectable penicillin provided for persons with evidence of syphilis.

"This mass treatment approach was selected for STD control to optimize compliance, population coverage, and therapeutic efficacy," says Dr. Wawer.

In order to test the hypothesis that intensive control of STDs will reduce HIV transmission, the rates of new HIV infections in the treatment communities will be compared to those in the control communities. In the latter, for ethical reasons, all persons with symptoms or laboratory evidence of STDs will be referred to highly accessible project clinics to receive STD treatment as provided by the Ugandan Ministry of Health.

If the research confirms the effects of STD treatment on HIV transmission, Dr. Wawer believes that the mass treatment strategy can be simplified and adapted for use in large-scale programs in regions with inadequate clinical services and high rates of STDs and HIV.

Stroke Research

Approximately 40 percent of ischemic stroke is of unknown etiology. Several methods, including blood thinning agents and clotting surgery, are used to reduce recurrence rates. However, the efficacy of these methods has not been proved clinically.

Several stroke studies are ongoing at P&S.

In 1992, Columbia University was awarded a $18 million grant from the National Institutes of Health to conduct the Warfarin-Aspirin Recurrent Stroke Study, a six-year, 39-center trial led by Dr. Jay P. Mohr, the Daniel Sciarra Professor of Neurology and director of the stroke unit at the Neurological Institute. This study assesses the efficacy of the blood-thinning agent warfarin and aspirin in preventing stroke recurrence in patients with first stroke.

A team led by Dr. Shunichi Homma, associate professor of clinical medicine and director of echocardiography service, recently received a NIH award of approximately $1 million to conduct the Patent Foramen Ovale (PFO) in Cryptogenic Stroke Study. This study will use transesophageal echocardiography to evaluate stroke patients for the presence or absence of patent foramen ovale, a hole in the heart, or other heart characteristics.

"PFO is found commonly in 10 to 20 percent of the population without producing stroke," says Dr. Homma, "so there must be other risk factors present in these patients that induce stroke."

Since 1993, Dr. Ralph Sacco, assistant professor of neurology and of epidemiology, has been conducting the Northern Manhattan Stroke Study, a five-year, case-control trial designed to assess the risk factors for stroke among the population in Northern Manhattan. Rather than looking for epidemiological factors, such as serum cholesterol and family history, Dr. Sacco will look for heart abnormalities, using transthoracic echocardiogram and contrast injection, to assess the importance of patent foramen ovale in this population at high risk for stroke.

Also, the research team, led by Dr. Marco Di Tullio, assistant professor of cardiology and assistant director of Echocardiography Service, recently received approximately $1 million from NIH to conduct the PFO Case Control Study. The population enrolled in Dr. Sacco's study will be used in this effort to assess the risk of PFO and blood-clotting abnormalities for stroke. In addition, the researchers will look for deep venous thrombosis in the legs, a condition thought to produce clots that result in stroke.

"The consortium of stroke-related grants was made possible by strong interdisciplinary cooperation between the Department of Medicine and the Stroke Unit of the Neurological Institute," says Dr. Homma. "This collaborative research effort represents the best of interdisciplinary coordination that is likely to become a model for future cost-effective research programs."