Refining Current Scientific Priorities and Identifying New Scientific Gaps in HIV-Related Heart, Lung, Blood, and Sleep Research

Abstract

The National Heart, Lung, and Blood Institute (NHLBI) AIDS Program's goal is to provide direction and support for research and training programs in areas of HIV-related heart, lung, blood, and sleep (HLBS) diseases. To better define NHLBI current HIV-related scientific priorities and with the goal of identifying new scientific priorities and gaps in HIV-related HLBS research, a wide group of investigators gathered for a scientific NHLBI HIV Working Group on December 14-15, 2015, in Bethesda, MD. The core objectives of the Working Group included discussions on: (1) HIV-related HLBS comorbidities in the antiretroviral era; (2) HIV cure; (3) HIV prevention; and (4) mechanisms to implement new scientific discoveries in an efficient and timely manner so as to have the most impact on people living with HIV. The 2015 Working Group represented an opportunity for the NHLBI to obtain expert advice on HIV/AIDS scientific priorities and approaches over the next decade.

Keywords: HIV epidemiology; HIV/AIDS pathogenesis; implementation science.

FIG. 1.

Epidemiological studies lead to novel hypotheses on the pathogenesis of HIV-associated complications, which in turn inform novel prevention and treatment. Ultimately, implementation science is necessary to create a scientific environment to address all these steps and to move new discoveries into clinical practice.

FIG. 2.

Chronic inflammation is a major driver of heart, lung, and blood complications in the HIV-infected population. While some compartments may have predominant drivers of inflammation, it is likely some inflammatory mechanisms are common to more than one compartment. Thus, platelet dysregulation will have the most effect on the blood and heart. An altered microbiome and virome are important in lung and blood complications. Oxidative stress may preferentially affect the lung and heart. Chronic inflammation is a common unifying end result of perturbations in all three compartments.

FIG. 3.

While chronic inflammation contributes substantially to HIV comorbidities, perturbations in the microbial environment remain critically important due to (1) lack of access of many HIV-infected populations to effective antiretroviral therapy, which can still lead to infectious complications, and (2) perturbation in the microbial milieu that directly or indirectly contributes to chronic inflammation. Chronic inflammation and abnormalities in the microbial milieu are further influenced by external factors such as tobacco abuse, other HIV risk factors, and geographic variation.