PROJECT SUMMARY/ABSTRACT Air pollution is a leading cause of mortality globally, contributing to nearly 1 in 10 deaths and 147 million years of healthy life lost annually. Fine particulate matter (PM2.5) is a key component of air pollution; it is highly regulated and is the component of the air pollution mixture most consistently and strongly associated with cardiovascular and respiratory mortality. While exposure to PM2.5 is associated with adverse cardiopulmonary effects in the general population, associations are even stronger among susceptible populations, including those with preexisting cardiovascular or respiratory disease. Identifying subgroups experiencing differential PM2.5-related health effects is key to informing policy and intervention strategies to protect our most vulnerable populations. There are 38 million people with human immunodeficiency virus (HIV) infection worldwide and 1.7 million new HIV infections each year. Improvements in antiretroviral therapy have led to longer life expectancies for people with HIV, but other health risks have arisen from chronic infection. Cardiopulmonary disease is a leading cause of morbidity and mortality among people with HIV due to long-term inflammation from infection as well as some antiretroviral therapy. Further, people with HIV may be at higher risk for adverse cardiopulmonary health effects from traditional risk factors as compared to the general population. The majority of the world's population is exposed to PM2.5 levels higher than the World Health Organization's (WHO) guideline for healthy air, but it is unknown if people with HIV are more susceptible to cardiopulmonary disease resulting from this exposure than the general population. The specific aims of this project are to 1) examine HIV infection as a potential modifier of the association between PM2.5 and systolic blood pressure, and 2) examine HIV infection as a potential modifier of the association between PM2.5 and percent predicted forced expiratory volume in the first second (FEV1). This study will take place in Matlosana, South Africa, a peri-urban district experiencing a confluence of high HIV prevalence and ambient PM2.5 levels regularly exceeding the WHO's 24-hour guideline of 25 µg/m3. With 7.5 million people with HIV, South Africa has the highest absolute burden of HIV in the world and an increasing burden of cardiovascular disease and chronic obstructive pulmonary disease (COPD). South Africa also has the second highest age-standardized death rate attributable to air pollution among all sub-Saharan African countries. The career development plan includes didactic and experiential training in cardiopulmonary physiology and air pollution exposure assessment, which will help the candidate implement the current project with fidelity and achieve her long-term goals of reducing air pollution exposure and prevent cardiopulmonary disease among people with HIV. She will have the support of a mentoring team and Advisory Committe...