Dr. Matthew Freiberg, University of Pittsburgh, discusses the HIV-CVD Collaborative

Dr. Matthew Freiberg, University of Pittsburgh:  The [HIV-CVD Collaborative] initiative was started about five years ago, and multiple grants were given to multiple groups around the country looking at HIV and cardiovascular disease. I am trying to think of the exact number of groups; I want to say it is eight, but I do not want to misquote myself. They are from multiple places- UCSF, UCLA, Miami, New York, Hopkins, Pittsburgh, Yale, Indiana- there are multiple investigators. 

The neat thing about this collaborative has been that people are approaching the issue of HIV and cardiovascular disease from multiple different angles. In this group, we have had people at Indiana, for instance, who ran a clinical trial. We have had people within the set of Indiana, we have ACTG involved with Judy Courier and Jim Stein out at UCLA. Again, we have people at UCSF looking down at some of the T-cell activation and some of the adaptive immune systems we have talked about earlier. We have a cohort with children with HIV with Tracy Miller down at Miami. We have the Ys and the X groups, which are really established cohorts for HIV contributing to subclinical measures of disease in women and men. VACS, our study has been looking both HIV infected and uninfected veterans. You have all these different groups of people who have HIV and trying to understand cardiovascular disease. 

One of the most powerful things about it is, HIV is not this homogeneous disease. HIV affects women, men, minorities, older, younger, 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. Having all these different groups, and I forgot to mention Partners out in Boston also. All of these different groups are trying to provide their two cents in, so that when we put it all together we try to get this global picture of HIV and cardiovascular risk. 

The second big thing that is important about this collaborative that I really like is that they are not all infectious disease or general internists or cardiologists. We have endocrinologists, we have general internists, we have infectious disease, we have cardiology, we have basic scientists, and we have immunology. When you get all these people, you know the elephant may be HIV, but it is really hard to look at the entire elephant. You have people looking at the trunk, or the leg, or the tusk, or the eye. When you get all these people to sit in the same room or talk about working on projects together, the science improves because people are putting in their two cents that way too. 

When you have their data from the different cohort, and different parts of the country with different types of HIV infected people, and that data is reflective of the different initiatives based on your area of expertise and what is interesting to you, you get a bigger picture. Nobody goes to the Louvre, looks at the Mona Lisa, and stares at her nose. It does not happen. You look at the whole picture and you say, what do I see? This collaborative, I think and what I have liked about it, and when we have talked at these meetings and you see the work that is happening, you are getting to look at the whole Mona Lisa, not just her nose. 

I am hoping that this collaborative continues and I am hoping that more people get a chance to join it or work with us to move this forward, because the more thoughts that we have, the better it will be. I can tell you as an example within this collaborative, and I will take our cohort in particular, we had two posters presented at the AHA, one from UCSF in sudden cardiac death and another one from Washington D.C. looking at defibrillator placement. Neither of these people are veterans aging cohort study investigators. None of these people are even in the collaborative, but they have seen the work that the collaborative have done. They contact us and they say, hey, you have access to data. Can I answer this question? I am a fellow or I am junior faculty and I would really like to investigate this and present it. We have provided those resources, because those resources were provided to us from the NHLBI. 

We are trying, as other people are in this group, to allow not just the people that are part of the collaborative, but others to access these data to move the initiatives forward. At the end of the day, if you have a larger community, you are likely to get more discoveries. My hope is that this collaborative continues, and I think that with the inner circle working together to try to move the initiative forward, but also expanding that circle to include people from the outside who are interested, I think we have a chance. 

I know just recently that the NHLBI has released RFA’s both for basic science and clinical research. Our group and others I am sure will apply, but I am hoping other groups do too, whether they have their own cohorts or through groups like us so that we get a chance to maximize the science we have learned over the first five years.