Mentored Scientist Award

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.

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.

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.

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.

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.

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.