Pilot Award

Abstract Alcohol consumption is a critical driver of the HIV epidemic in sub-Saharan Africa. Among those with HIV, alcohol consumption has consistently been associated with reduced antiretroviral adherence crucial for treatment as prevention. Thus, reducing alcohol use among those with HIV is a high priority. Brief interventions to reduce alcohol use (ABI) have been efficacious in primary care in developed countries. However, the usefulness of ABIs depends on effective screening for unhealthy alcohol use.

Abstract Alcohol consumption is a critical driver of the HIV epidemic in sub-Saharan Africa. Among those with HIV, alcohol consumption has consistently been associated with reduced antiretroviral adherence crucial for treatment as prevention. Thus, reducing alcohol use among those with HIV is a high priority. Brief interventions to reduce alcohol use (ABI) have been efficacious in primary care in developed countries. However, the usefulness of ABIs depends on effective screening for unhealthy alcohol use.

Millions of HIV-infected individuals are now receiving life-saving ART, but with evidence of ongoing immune dysfunction despite treatment and the current absence of an effective cure, HIV cure has emerged as an important research strategy. This pilot non-human primate study will evaluate the tolerability and biologic effect of increasing doses of Euphorbia kansui, an inexpensive, readily available herbal supplement used in Traditional Chinese Medicine (TCM) shown to reactivate latent HIV-1 in an in vitro model.

Millions of HIV-infected individuals are now receiving life-saving ART, but with evidence of ongoing immune dysfunction despite treatment and the current absence of an effective cure, HIV cure has emerged as an important research strategy. This pilot non-human primate study will evaluate the tolerability and biologic effect of increasing doses of Euphorbia kansui, an inexpensive, readily available herbal supplement used in Traditional Chinese Medicine (TCM) shown to reactivate latent HIV-1 in an in vitro model.

Despite the success of highly active antiretroviral therapy (HAART), many HIV-infected patients never achieve a CD4 recovery greater than 500 cells/mm3 even after many years on treatment. Poor immune reconstitution, despite good virologic control, is associated with low baseline CD4 count, old age, and co-morbid disease. While a number of interventions have been suggested to improve immunologic outcomes for those at risk for incomplete CD4 T cell response, very few have successfully improved outcomes for patients with poor initial immune recovery.

Despite the success of highly active antiretroviral therapy (HAART), many HIV-infected patients never achieve a CD4 recovery greater than 500 cells/mm3 even after many years on treatment. Poor immune reconstitution, despite good virologic control, is associated with low baseline CD4 count, old age, and co-morbid disease. While a number of interventions have been suggested to improve immunologic outcomes for those at risk for incomplete CD4 T cell response, very few have successfully improved outcomes for patients with poor initial immune recovery.

Antiretroviral therapy (ART) has demonstrated efficacy and durability in suppressing HIV replication in infected individuals. However, ART does not achieve viral eradication due to the persistence of latently infected cells. The eradication of HIV necessitates elimination of this reservoir. Methods to reactivate HIV latently infected cells allowing direct viral cytopathic effects or immune-mediated clearance are being considered as cure strategies. However, existing latency-reversing agents exert weak effects on HIV reactivation.

Antiretroviral therapy (ART) has demonstrated efficacy and durability in suppressing HIV replication in infected individuals. However, ART does not achieve viral eradication due to the persistence of latently infected cells. The eradication of HIV necessitates elimination of this reservoir. Methods to reactivate HIV latently infected cells allowing direct viral cytopathic effects or immune-mediated clearance are being considered as cure strategies. However, existing latency-reversing agents exert weak effects on HIV reactivation.

The overarching goal of this cross-sectional study is to examine if co-morbid heavy alcohol use is associated with innate immune activation and expression of inflammatory genes in HIV-positive, methamphetamine-using men who have sex with men (MSM) treated with anti-retroviral therapy (ART). Chronic activation of the innate immune system and inflammation are independently linked to an excess risk of age-related morbidity and mortality in HIV.

The overarching goal of this cross-sectional study is to examine if co-morbid heavy alcohol use is associated with innate immune activation and expression of inflammatory genes in HIV-positive, methamphetamine-using men who have sex with men (MSM) treated with anti-retroviral therapy (ART). Chronic activation of the innate immune system and inflammation are independently linked to an excess risk of age-related morbidity and mortality in HIV.