Mentored Scientist Award

A recent meta-analysis showed that in sub-Saharan Africa, approximately one in five couples experience infertility, defined as the inability to become pregnant after 12 months of unprotected intercourse. Women living with HIV face even higher infertility rates compared to their HIV negative counterparts. In Kenya, adolescents and young women are contracting HIV faster than any other subgroup and carry twice the burden of HIV compared to men (6.6% vs 3.1% respectively).

Male sex workers who have sex with men (MSMSW) are under-represented in most contemporary HIV prevention research efforts. While MSMSW face unique challenges and occupational risk factors as a result of their work, there is a dearth of current literature describing the uptake of HIV and STI prevention services in the form of HIV pre-exposure prophylaxis (PrEP) and/or STI chemoprophylaxis (e.g., DoxyPEP/DoxyPrEP) among MSMSW. Further, MSMSW are not a monolithic group.

Clonal expansion is a major driver of HIV persistence in antiretroviral therapy (ART)-suppressed people with HIV (PWH). This clonal expansion is facilitated by homeostatic proliferation, primarily orchestrated by cytokines like IL7 within tissue reservoirs, the main site of HIV persistence. Recent studies have identified CD127, the alpha chain of the IL7 receptor crucial for IL7 signaling, as a defining marker of long-lived CD4+ T memory (Tm) cells from human tonsils that preferentially undergo latent HIV infection.

HIV/SIV has evolved numerous strategies to evade the immune system, complicating efforts to develop effective prophylactic or therapeutic vaccines. Critical to this evasion is the virus's ability to undergo rapid antigenic variation and elicitation of lower-avidity vaccines by many of the most widely used vectors. These factors significantly influence the effectiveness of the immune response against HIV/SIV, affecting the recognition and elimination of infected cells by CD8+ T-cells.

Hazardous alcohol and opioid use are prevalent among persons with HIV (PWH) in the United States, and contribute to adverse outcomes including HIV disease progression,9,10 various co-morbidities, and mortality. A significant proportion of PWH co-use alcohol and opioids, which worsens HIV-related outcomes. Despite the notable prevalence of these types of substance use and their related negative sequelae, alcohol and opioid use are frequently underdiagnosed among PWH in part due to the widespread use of self-report which is prone to underreporting.

HIV infection increases risk of tuberculosis (TB) disease. Antiretroviral therapy (ART) decreases TB risk, yet it remains strikingly higher than in people without HIV. HIV increases immune dysfunction, impairing T helper (Th)1, Th17 cells and expanding regulatory responses, all of which likely increase TB risk. Furthermore, other immune activation pathways, such as the kynurenine pathway of tryptophan catabolism (KP) are upregulated in HIV and remain abnormal despite ART.

Cisgender women living with HIV (WLHIV) are more likely to both enter menopause early and suffer from comorbidities associated with menopause, such as low bone density and cardiovascular disease, than their HIV-negative counterparts. Menopause can also increase symptom burden in WLHIV and affect antiretroviral adherence. However, these women are less likely to use menopause hormone therapy (MHT), a treatment known to minimize menopause’s effects.

Post-tuberculosis lung disease (PTLD), a heterogeneous group of abnormalities including obstructive (airway), restrictive (fibrotic), pleural, and pulmonary vascular diseases, occurs in approximately 50% of people with cured tuberculosis (TB) and is a source of significant morbidity. HIV is a known risk factor for TB and for more severe disease, but its impact on PTLD is unclear.

Persons living with HIV (PLWH) face an increased risk of atherosclerotic cardiovascular disease (ASCVD) compared with the general population. However, much of this data is derived from high-income populations. Emerging data from parts of sub-Saharan Africa indicate challenge this risk outcome paradigm. Although HIV is known to be associated with myocardial inflammation and fibrosis in both high- and low-income settings including sub-Saharan Africa, HIV’s effect on vascular disease appears to differ between these geographies.