Tremendous progress in the treatment of HIV has led to increased survival and a dramatic evolution of the disease’s course in patients. The clinical challenges confronting the population have now shifted from AIDS-related illnesses to chronic diseases, such as coronary artery disease, chronic obstructive lung disease, and chronic anemia. Multiple studies have demonstrated that the risk of developing heart, lung, and blood (HLB) disease in HIV patients is significantly higher and may be accelerated compared to the general population. In addition, the mechanisms of HIV-related HLB disease may be different because of the adverse effects of antiretroviral therapy (ART) and a greater contribution of inflammation and other factors.
The Heart
“NHLBI has supported research that has led to significant advances in the understanding of HIV-related cardiovascular disease (CVD),” Dr. Shah said. “Based on work the Institute has supported, we are gaining a better understanding of the central role of inflammation in HIV-related CVD. We are also learning more about the epidemiology of HIV-related CVD. For example, recently published research supported by the NHLBI AIDS Program demonstrated that rates of myocardial infarction are significantly higher in HIV-positive individuals compared to non-infected individuals. Findings like these are providing a greater understanding of the impact of HIV-related CVD and laying the groundwork for future investigations.”
A key program at NHLBI that focuses on HIV-related CVD is the HIV-CVD Collaborative. The major goals of this program are to support research that addressed mechanisms and potential future therapeutic interventions for HIV-related CVD and foster multi-disciplinary collaboration. Many of the grants funded via the Collaborative program are now in their final year or are in no-cost extensions and the grantees are expected to publish their findings in the near future.
One grantee involved in the Collaborative is Dr. Judith Currier, professor of medicine in the Division of Infectious Diseases, Department of Medicine, University of California Los Angeles (UCLA) and associate director of the UCLA Center for Clinical AIDS Research and Education.
Dr. Currier is an infectious disease physician who has long held an interest in the intersection between HIV infection and cardiovascular disease. When the initiative first launched, Dr. Currier submitted and got funded a proposal with cardiologist James Stein from University of Wisconsin to focus on the effects of HIV therapy on the development and prevention of CVD. More specifically, the research is examining the impact of three modern antiretroviral therapy (ART) treatment strategies on the progression of atherosclerosis in individuals with HIV infection who had not been taking any ART prior to study participation. One of the strengths of the project is that it built upon the AIDS Clinical Trials Group Network (ACTG), an existing initiative funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID). This meant that Drs. Currier and Stein didn’t have to recruit patients, but instead were able to conduct their research on patients already enrolling in the ACTG.
“I was really excited about the opportunity to partner with NHLBI to really investigate more thoroughly the cardiovascular aspects of antiretroviral therapy by bringing the NHLBI grant into the ACTG study,” Dr. Currier said. “The ACTG couldn’t have paid for or supported the cardiovascular work, so it was a great efficiency to be able to bring the two studies together.”
Since receiving that first grant, Dr. Currier has expanded her relationship with the NHLBI – including receiving funding for two R01 grants – and her collaborations with cardiovascular specialists. Her funded projects include investigating HDL function in individuals with HIV. One of her teammates on that project has developed a new assay for measuring HDL function that is allowing researchers to try and better understand how the inflammation that occurs in HIV might contribute to impaired function of HDL cholesterol.
The results of Dr. Currier’s original project, “Prospective Evaluation of Antiviral Therapy and Cardiac Health,” will come out later this year. She also indicated that she expects many other results from HIV-CVD Collaborative projects also will come out this year, and many of those results are expected to be presented during the annual Conference on Retroviruses and Opportunistic Infections (CROI) and the American College of Cardiology Scientific Session, both in March.
“This first round of research from the HIV-CVD Collaborative has really generated more questions than answers,” Dr. Currier said. “All of us who have been involved are thinking about next steps.
“One of the most powerful aspects of the collaborative has been that people are approaching the issue of HIV and cardiovascular disease from multiple different angles,” said Dr. Matthew Freiberg, an associate professor of medicine and epidemiology at the University of Pittsburgh Medical Center and a member of the HIV-CVD Collaborative. “HIV is not a homogeneous disease. HIV affects women and men, all minorities, older people, younger people, people with substance use issues, people without substance use issues. If you want to understand what HIV is doing, one cohort is not going to get it done. All of these different groups in the Collaborative are approaching HIV from different directions, and when we put it all together, we can start to see a more global picture of HIV and cardiovascular risk.”
In a recent interview with NHLBI Director Dr. Gary H. Gibbons, Dr. Freiberg discussed the HIV-CVD Collaborative and his research.
Learn more about Dr. Freiberg’s research on the effect of HIV on CVD and the role that Big Data plays in his work.
Dr. Currier agreed with Dr. Freiberg’s sentiments about the power of the Collaborative’s interdisciplinary focus.
“It’s been really great to work with a range of multidisciplinary research teams from different backgrounds and find ways to more efficiently bring resources together to apply to these problems,” she said. “HIV is an infection that has multi-organ system effects and it’s critical that we find ways to bring together the expertise that’s needed form different disciplines to try to understand these problems. The NHLBI AIDS Program has done a nice job in facilitating that.”
This is the first in a three-part series about the NHLBI AIDS Program. Part Two is an installment about the intersection of HIV and lung diseases and Part Three is about HIV and blood research.