Mentored Scientist Award

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.

In the United States, nearly a third of those diagnosed with HIV were diagnosed late, meaning that they were diagnosed with AIDS at the same time as or within one year of their HIV diagnosis. Late HIV diagnosis is associated with poor treatment outcomes and, in turn, less viral suppression, greater transmission of HIV to those who are not infected, and increased HIV-related morbidity and mortality. The United States’ goal of reducing HIV in part by increasing peoples’ awareness of their HIV status cannot be achieved without addressing late diagnosis.

Maternal and neonatal mortality and morbidity are persistently high in Uganda where there is also a generalized HIV epidemic. Ensuring early and appropriate antenatal care (ANC) allows for screening, treatment, and prevention of complications, while offering education and support to ensure healthy pregnancies and maternal and fetal outcomes. Few Ugandan women initiate antenatal care in the first trimester, as recommended. Timing of antenatal care initiation may vary by serostatus but there is little research on this.

Men in occupations that require high mobility, such as fishing, are particularly vulnerable to lapses in HIV prevention engagement. Kenya has been a leader in scaling up biomedical HIV prevention, including oral PrEP. However, in preliminary data from the Owete study, we found that uptake of HIV prevention, including daily oral PrEP, is low (3.8%) despite availability in government health facilities at no cost.

Immunocompromised individuals, including people living with HIV (PLWH), are more vulnerable to severe COVID-19 as compared to immunocompetent individuals. It remains unclear whether vaccines and previous infection stimulate equivalent immune defenses in PLWH, although HIV+ individuals have a higher rate of breakthrough infection than HIV- individuals post-vaccination. Recent studies have demonstrated that the quality and perhaps quantity of SARS-CoV-2 antibodies elicited by mRNA vaccines are diminished in ART-suppressed people living with HIV as compared to uninfected individuals.

Persons living with HIV (PLWH) are twice as likely to develop cardiovascular disease (CVD), and this excess risk persists despite viral suppression with antiretroviral therapy (ART). In the past 20 years, the global burden of CVD in PLWH has tripled, accounting for significant disease burden. Dyslipidemia is one mechanism by which HIV infection is associated with atherosclerotic CVD (ASCVD), partly due to side effects of ART.