Letters from the Director: Better Understanding the Nature of Comorbidities in People with HIV

Nearly four decades ago when the HIV/AIDS epidemic began, communities around the globe were experiencing illness and fear as the world faced a new and unknown virus that was certain to cause death to those who tested positive for it. Currently, however, through decades of hard work, significant investments, and ongoing investigations, the epidemic has been reduced to a manageable chronic disease that is controlled by interventions and scientific advancements including antiretroviral therapy (ART). Today’s prevention and treatment modalities allow people at risk for or affected by HIV to live longer, healthier lives.

Approximately half of HIV infected patients in the United States are over 50 years of age and more likely to suffer health complications as a result of treatment. The changing epidemiology of HIV in the ART era needs to be further explored to optimize the health of people with HIV. Although ARV treatments lead the way as a clinical management approach proven effective in people with HIV, much remains to be better understood. For example, while people with HIV can reach nearly normal life-spans when treated with ART, they are more likely to suffer chronic HIV-related comorbidities. More studies and investigations must be conducted to assess the impact of HIV treatment on people with HIV and the inner workings of immune suppression.

In April 2019, the National Institutes of Health (NIH) Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) studies that began in 1984 and 1994 respectively, were combined into a single cohort known as the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) with nearly 5000 active participants. While continuing to further efforts on preventing HIV, the NIH shift the emphasis of support for this study to research HIV-related comorbidities.

While the former MACS cohort comprises gay and bi-sexual men, the former WIHS cohort includes women with other HIV-risk factors. The MACS/WIHS-CCS, which runs on a seven-year funding cycle, will recruit underrepresented participants, including Black and Hispanic men and women from the southern region of the United States, to achieve closer balance in the numbers of participants at each Clinical Research Site, render a more diverse cohort that reflects the U.S. HIV-positive population, and replace deceased participants or those lost to follow-up.

In close collaboration with the Office of AIDS Research (OAR), the National Heart, Lung, and Blood Institute (NHLBI) will serve as the primary steward of this initiative, along with 14 co-funding institutes that include, NCI, NIA, NIAID, NICHD, NIDCR, NIDA, NIMH, NINDS, NINR, NHGRI, NIMHD, NIDDK, NIAAA, and NIDCD. The initiative will enable high-impact investigations of one of the highest priorities of HIV-infection research supported by NIH: the clinical epidemiology of heart, lung, blood and sleep and other HIV-related comorbidities in the ART era.

The FY2019 combined level of core funding for the Clinical Research Sites and the Data Analysis Coordinating Center is approximately $42 million. Future year amounts will depend on annual appropriations. Research interests will include:

• Basic research on immune activation, viral resistance and HIV reservoirs.
• Epidemiology of HIV-related comorbidities and earlier clinical signs.
• Implementation of guidelines to reduce the public health burden of HIV-related comorbidities.

Scientific advances in antiretroviral therapy enable the MACS and WIHS studies to now address chronic comorbidities for those living with HIV. As the research focus shifts, new investigators and scientific working groups have emerged or taken on greater prominence, including groups focused on pulmonary, cardiovascular, neurologic, and cognitive HIV-related comorbidities.

This OAR collaboration with NHLBI and co-funding institutes is crucial to better understand the nature of HIV-related comorbidities among people with HIV who experience more frequent and severe morbidities than those without HIV. The initiative will also seek to provide a better understanding of modalities that may help address the effects of HIV infection in the absence of effective therapy.

For additional details, please https://www.nhlbi.nih.gov/science/macswihs-combined-cohort-study

Maureen M. Goodenow, Ph.D.
Associate Director for AIDS Research and
Director, Office of AIDS Research
National Institutes of Health