Project Summary/Abstract Infection with HIV significantly increases the risk of a host of non-communicable diseases (NCDs) including cancer, cardiovascular disease, and pulmonary disease. In the era of widespread availability of antiretroviral therapy and the corresponding increased life expectancy of persons with HIV (PWH), the incidence of NCDs has increased and now is the leading cause of death. Unfortunately, substantial gaps remain in understanding how HIV-infection potentiates the development of cancers and other NCDs, how to best prevent the development of the chronic complications of HIV infection, and how cancers and NCDs are optimally treated in PLHW. The Biomarkers, Prevention and Interventions for HIV-Associated Malignancies and NCDs (BPIN) Core is a new Core that provides faculty expertise, diagnostic assays, imaging resources, access to biorepositories, and mentoring related to both cancers and NCDs, building on the highly successful HIV- Associated Malignancy (HIVAM) Core. In the past decade, the HIVAM Core collected data and biospecimens from PWH who either were at risk for or who had already developed cancer, enabling impactful translational, epidemiologic and clinical research. Access to tumor tissue and other biologic materials that are collected through rigorous internationally-validated protocols and annotated with data that are critical to the understanding of cancer biology has allowed CFAR-affiliated investigators to make important insights into the pathogenesis, prevention and treatment of HIVAM including Kaposi Sarcoma, Non-Hodgkin Lymphoma, Cervical Cancer and Breast Cancer. Developmental efforts by the HIVAM Core fostered both the careers of new investigators as well as established cancer researchers who bring their skills to HIVAM. Based on these successes, as well as input from our local and international CFAR community, we have expanded our focus to cardiovascular and pulmonary disease in HIV infection, providing CFAR members access to expert, imaging libraries and samples from longitudinal cohorts in East Africa. The BPIN Core has three Specific Aims: 1) Support new and established researchers in the fields of NCD with the tools to design and implement impactful studies among PWH; 2) Collect and disseminate high-dimension data and appropriately-preserved biospecimens from PWH with or at risk for NCDs to CFAR investigators who seek to conduct basic and translational studies; and 3) Develop and distribute state-of-the-art tools for novel studies of NCDs among PWH, including image analysis, histopathology, and molecular diagnostic assays. Through these aims, CFAR members working with the BPIN core will discover and evaluate biomarkers for the prevention and management of NCDs, describe the role of inflammation, environmental factors and genetics in the development of NCDs, and develop new interventions for the prevention and treatment of NCDs among PWH in the US and sub-Saharan Africa.