I recently watched the Suter Science Seminar with guest lecturer Dr. Chris Longenecker. This seminar focused on inflammation and heart disease in patients with HIV. I found this seminar particularly interesting because this was the first time I had heard about a relationship between those two different aspects. Below is a summary of the seminar, which I hope you all will find equally interesting =)

Dr. Longenecker  is a former EMU student who is now a professor working at Case Western University Medical School. He partakes in translational medicine research, which focuses on using basic scientific discoveries and translating these into various realms involving patients, medical practices and bigger populations. During this lecture, Dr. Longenecker sheds light on three different aspects: inflammatory biomarkers that predict risk of cardiovascular disease in HIV patients, possible drugs to reduce risk of cardiovascular disease in HIV patients and finally, whether or not HIV interacts with other cardiovascular conditions by making them better or worse. Finally, Dr. Longenecker ends the lecture by highlighting three important characteristics of translation medicine, which include collaboration, innovation and empowerment.

Thirty seven million people in the word currently have HIV. This disease is still primarily transmitted from male to male, however the incidence of women with HIV is also increasing. One million people in the United States have been infected with HIV and Dr. Longenecker notes that an alarming 15% of those infected are unaware that they have the disease. Sub-Saharan Africa continues to have the highest concentration of HIV infected individuals. Since the discovery of HIV many years, antiretroviral drugs (i.e. integrase and protease inhibitors) have been created and steadily improved over time in terms of both efficacy and decrease of toxicity. In addition, HIV infected individuals are now able to take one pill a day to treat their illness and prolong life. Despite this however, only 30% of the 1.2 million infected HIV patients in the United States are virally suppressed.

In the 90s, there was an increase in the amount of HIV patients coming to the hospital with myocardial infarctions. After undergoing research to understand this issue, an association was found between HIV and a 1.5-2 times higher risk of acquiring cardiovascular diseases such as myocardial infarctions, heart failure, stroke and atrial fibrillation. In the beginning of the lecture, Dr. Longenecker mentions four “take-home messages”, one of these being that treated HIV-infection is a chronic inflammatory disease more than an immunodeficiency disease. Further, inflammation is a key player in the damage of the heart and blood vessels, which can ultimately lead to clinical cardiovascular disease. To investigate the link between inflammation and cardiovascular disease, biomarkers of inflammation (i.e. D-dimer) and imaging studies (i.e. carotid ultrasound) can be obtained to observe for cardiovascular disease. Studies have revealed that an increase in positive biomarkers is likely to lead to the diagnosis of a type of heart disease. However, Dr. Longenecker summarizes the results of a trial done on a small population of HIV patients with high levels of inflammation. The trial specifically focused on the effects of statin administration on inflammation and results ultimately did suggest that this drug did decrease inflammation over time.

As mentioned previously, Dr. Longenecker highlights three important aspects of translational medicine: empowerment, collaboration and innovation. Dr. Longenecker, along with other individuals, brought these principles to Kampala, Uganda in order to help build the cardiovascular workforce in this country. Primarily however, Dr. Longenecker collaborated with a group of colleagues to partake in the rheumatic heart disease initiative (RHD). A significant incidence of HIV patients were noted to have RHD, thus action was taken in order to create treatment plans for these patients. The process to RHD is as follows: repeated incidences of Group A Strep, followed by intermittent fevers and eventually progression into RHD, which is an autoimmune disease leading to inflammation of the myocardium and valvular tissue. A high correlation was found between HIV and RHD in Africa, therefore a study with 500 HIV infected children was done to understand this correlation in Uganda. After these children were screened, results ultimately revealed a 0.8% prevalence of RHD. In addition, it was noted that HIV was associated with a decreased prevalence of RHD. One theory that was proposed for this finding is that these individuals are able to obtain regular treatment to treat their ongoing HIV symptoms. Another theory proposed that the administration of a drug called Cotrimoxazole to treat Group A Strep may have also decreased the incidence of RHD in this population. While this research is promising, further investigation and research is still necessary in the future to further understand the mechanisms of inflammation and heart disease in patients with HIV.