Mentored Scientist Award

HIV risk and mental health morbidity are high among transgender women in Lebanon. We culturally adapted and pilot-tested an existing intervention in the Lebanese context. ‘Baynetna’ (Arabic for “between us” and a play on the word for “girls”) shows great promise to impact HIV risk and mental health through the model of Gender Affirmation for increasing community connectedness via trans-facilitated small group support.

Dolutegravir was recently recommended as a component of first-line antiretroviral therapy (ART) for all adults living with HIV by the World Health Organization due to improved efficacy and tolerability over prior regimens. However, recent studies, including two randomized trials in sub-Saharan Africa, have shown significant weight gain associated with dolutegravir among ART-naïve patients newly initiating dolutegravir. It is not known whether switch to dolutegravir among ART-experienced patients will result in similar weight gain.

Trans women bear a disproportionate burden of HIV worldwide. Within this population, Black trans women face a disparity within this disparity, with higher prevalence of HIV and worse clinical outcomes. The extraordinarily high burden of HIV among Black trans women merits urgent investigation. This study proposes to investigate racial/ethnic disparities in the population most severely affected by HIV worldwide – Black trans women, with inclusion of African-Americans and Afro-Brazilians as part of the wider African diaspora.

Levels of cerebrospinal fluid (CSF) HIV antibodies are theorized as a broad marker of central nervous system (CNS) HIV reservoir size. In the proposed work, I will determine CSF HIV antibody levels and their antigenic targets in virally suppressed HIV+ elders with (n=30) and without (n=15) HIV-associated neurocognitive disorder (HAND).

The current limitations of antiretroviral therapy is driving interest in alternative therapeutics which fully resolve inflammation and achieve complete eradication of HIV latently-infected cells. Exosomes are nano-sized membrane vesicles and key players of intercellular signaling. Interestingly, exosomes have shown promise as engineerable therapeutic agents for a broad range of diseases. The objective of this grant is to surface engineer exosomes ex vivo using surface display technology and pack the decorated exosomes with cytotoxic cargo.

Evidence is mounting that gender-based violence (GBV) is a major barrier to engagement in HIV care and treatment, and viral suppression. Research has documented the powerful role of GBV on ART uptake and adherence, including a meta-analysis showing that intimate partner violence had a larger effect on adherence than other factors such as stigma, financial constraints, and pill burden. Yet four key gaps in knowledge remain.