Dramatic advances in treatments for HIV have changed the face of the HIV epidemic in the United States. People living with HIV are aging, and have increased heart, lung, and blood diseases compared to people without HIV. This project will fill important gaps in our knowledge about mechanisms and risk factors for development and complications of these conditions in people living with HIV, leading to new prevention and treatment strategies.
The population of people living with HIV (PLWH) in the US is aging; it is projected that by 2015 more than half of US PLWH will be over age 50. Heart, lung, and blood diseases are common among aging PLWH, likely due to a complex interplay of HIV infection itself and resulting inflammation, antiretroviral treatments and their toxicities, viral co-infections, other co-morbid conditions, traditional risk factors, and other behaviors such as substance use. We propose to rigorously assess risk factors associated with increased incidence of myocardial infarction (MI), venous thromboembolism (VTE) including pulmonary embolism and deep venous thrombosis (DVT), and chronic anemia among PLWH, and to determine risk factors associated with poor outcomes from these conditions. We are particularly interested in the role of modifiable risk factors. Understanding the contribution of multiple factors to the increased risk of disease is crucial to developing strategies to improve prevention, diagnosis, and treatment of these major heart, lung and blood diseases in PLWH. This application leverages comprehensive clinical data and biorepository samples from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS), a data source specifically suggested in the RFA. This large, diverse, well-characterized multi-site cohort captures longitudinal clinical data, patient reported outcomes such as physical activity, depression, and substance use, and also bio-specimens, facilitating a nuanced and detailed approach to addressing risk. In addition, CNICS infrastructure allows outcomes to be carefully reviewed and validated capturing key distinctions such as MI type (STEMI vs. non-STEMI) and DVT location. Our multidisciplinary team is uniquely poised to leverage these resources to address important gaps in understanding the pathophysiology, diagnosis, treatment, and impact of MI, VTE and chronic anemia in PLWH by pursuing 3 aims.
Aim 1 is to determine the incidence of MI, VTE and anemia in PLWH, and to identify modifiable HIV-specific and traditional risk factors.
Aim 2 is to determine immunologic predictors of MI, VTE and anemia among PLWH, focusing on soluble markers of inflammation, coagulation, monocyte activation, and gut epithelial integrity.
Aim 3 is to determine modifiable risk factors for complications and poor outcomes from these three conditions in PLWH.
Specific outcomes will include mortality, multi-morbidity, health-related quality of life, and frailty. These investigations can identify novl targets for therapeutic interventions. New knowledge gained from these investigations will inform clinical decision making and will improve understanding of the mechanisms of heart, lung, and blood diseases in PLWH, which in turn will enhance the development of rational and targeted therapeutic approaches to improve outcomes.