In 2011, where medicines are available, HIV/AIDS has become a chronic disease instead of a death sentence. That’s progress to celebrate, no question. However, the Hawai’i Center for AIDS has found HIV appears to lead to ‘premature aging’, which is presenting a new set of challenges.
Dr. Cecilia Shikuma, pictured, leads the John A. Burns School of Medicine’s AIDS investigators, at the University of Hawai’i at Mānoa. To mark World AIDS Day, Dr. Shikuma’s team is reporting its findings and where they expect their research to take them next.
• The Hawai’i Center for AIDS has demonstrated conclusively through “fat biopsy studies” that early-generation AIDS drugs damaged parts of fat cells, leading to the disfiguring pooling of fat around the abdomen or upper back, for example, of some AIDS patients. This discovery led to the development of better drugs without this toxicity.
• From our ‘Memory Study’, we have learned that over half of our HIV infected population have some degree of cognitive impairment and that the risk is increased in our older HIV infected patients. Diabetes also is a risk for individuals with HIV cognitive impairment. Cognitive impairment includes reduced ability to think, concentrate, reason and remember.
• From our ‘Healthy Heart’ series of studies, we have learned that cardiovascular disease is higher than it should be in our HIV infected population, that those with heart disease have lower vitamin D levels (and that Niaspan, a common cholesterol medication, does appear to have a beneficial effect against hardening of the arteries).
“We want, more than anything, to thank the people of Hawai’i and the many individuals who unselfishly participated in our HIV/AIDS clinical research and trials,” said Dr. Shikuma. “Their participation has contributed to these significant advances in our understanding of HIV and its complications.” Shikuma also thanked the Hawai’i State Legislature for supporting the research program.
“As we look to the future, we will continue to participate in clinical trials intended to bring better and improved HIV medicines to our HIV infected patients,” said Shikuma.
The Center anticipates its major research efforts will concentrate on understanding why HIV leads to dementia, heart disease, osteoporosis, diabetes, kidney and liver disease and cancers.
“We suspect that these increases are due to the fact that HIV infected cells continue to circulate in the bloodstream, despite potent HIV medications that appear to mask the free virus in the blood,” said Shikuma. “We also believe the HIV virus has detrimental pro-inflammatory effects on various organ systems.”
By joining forces with scientists interested in studying the pro-inflammatory and ‘immune activation’ aspects of HIV, the Hawaii Center for AIDS hopes to discover why chronic complications are increased in HIV. The Center hopes to conduct a series of clinical trials focused in particular on HIV cognitive impairment and cardiovascular disease, with the goal of finding treatments and therapies to counter the increase in chronic complications.
An estimated 2,500 people in Hawai’i are infected with HIV. UH medical school doctors treat more than 400 AIDS patients in clinics on O’ahu, Maui, and Hawai’i Island.
Photo for the University of Hawai’i by Reese Moriyama.