Global HIV SWG Membership
Sten Vermund, M.D., Ph.D. (Co-Lead) VU (VIGH)
Muktar Aliyu, M.D. (Co-Lead) VU (VIGH) & MMC (Fam. Med.)
Carolyn Audet, Ph.D.
Philip Ciampa, M.D.
VU (Med, VIGH)
Stephany Duda, Ph.D.
Carol Etherington, MSN
Cynthia Gadd, Ph.D.
Douglas Heimburger, M.D. VUSM (Med, VIGH)
Marsha Kalish, Ph.D.
VUSM (ID/Med, VIGH)
John Koethe, M.D.
VUSM (ID/Med, VIGH)
Mary Lou Lindegren, M.D. VUSM (Peds., VIGH)
Cathy McGowan, M.D.
VUSM (ID/Med, VIGH)
Deidra Parrish, M.D. MSPH, TM
VU (VIGH, Med)
Waldemar Popik, Ph.D.
MMC (CAHDR, Micro)
Han-zhu Qian, Ph.D.
Wilson Silva, Ph.D.
Tim Sterling, M.D.
Christine Minja Trupin, Ph.D. MMC (Grad/Res)
Emilio Valverde, Ph.D.
VUSM (Prev Med)
Lara Vaz, M.D.
Alfredo Vergara, M.D.
Fehras Wehbe, Ph.D.
Bahr Weiss, Ph.D.
C. William Wester, M.D.
VUSM (ID/Med, VIGH)
Global HIV Scientific Working Group
The Global HIV (GH) WG was launched in 2008. It is co-directed by Sten Vermund, MD, PhD., and Muktar Aliyu, MBBS, MPH, DrPH. Dr. Vermund founded the Vanderbilt Institute for Global Health (VIGH). Dr. Aliyu holds faculty appointments at both Vanderbilt and Meharry, and leads VIGH programs in Nigeria.
The principal goals of the GH SWG are to study, in resource limited settings, the mechanisms and epidemiology of disparities in: HIV infection; AIDS; and outcomes of combination antiretroviral therapy (cART).
Some highlights of GH SWG efforts are listed below.
Caribbean, Central and South America network for HIV epidemiology (CCASAnet) and the International Epidemiological Databases to Evaluate AIDS (IeDEA) Network Co-ordinating Center (INCC)
CCASAnet is a vibrant clinical epidemiological collaboration, now renewed for a second term with CFAR Administrative Core and GH SWG intellectual support with Cathy McGowan, MD as PI. HIV databases for 7 Latin American nations are developed, maintained, audited, and used for epidemiological/outcomes research; the project was started by Dan Masys, MD, (now retired) and continues under Dr. McGowan as part of the global International Epidemiological Databases to Evaluate AIDS (IeDEA) network. As part of this group, Tim Sterling, MD, and his team work with colleagues in Peru (Universidad Peruana Cayetano Heredia) and Brazil (Federal University of Rio de Janeiro) on research related to TB and HIV, as well as other TB interests.
The GH SWG also expanded our CFAR’s IeDEA involvement with a successful application for the IeDEA Network Co-ordinating center (INCC) (Mary Lou Lindegren and William Wester, co-PIs). A key component of this INCC award involves cross-IeDEA network data handling and management harmonization, site assessments, and data coordination efforts, alongside ongoing data quality assurance, in order to advance the global IeDEA scientific agenda and foster multi-regional projects within the 7 region consortium. This includes analyses across regions and between “North-South” regions.
HIV and Tuberculosis research
Extending innovative tuberculosis research into additional countries, and new topics such as drug-resistance and nutrition effects on TB, is also a high priority. The GH SWG is actively developing new collaborations in Africa on drug resistant tuberculosis – where it could have greatest impact. Chris Fiske, a junior faculty member in Tim Sterling’s group, is now undertaking laboratory testing of a hypothesis based on epidemiological data that vitamin D decreases risk of extrapulmonary TB, and that excess extrapulmonary TB rates among blacks are due to immune defects caused by relative lack of vitamin D. The GH SWG is also working with Dr. Sterling to follow-up his recent, well-publicized, ground-breaking findings of the CDC’s TB Trials Consortium Study 26 presented at the American Thoracic Society International meeting in Denver in May 2011 of a short, once-weekly primary prophylaxis approach that is as good as daily INH over a 9 month course (PREVENT TB: Results Of A 12-Dose, Once-Weekly Treatment Of LTBI).
Innovative research in nutrition
The GH SWG has an innovative, strong focus on nutrition, food security and health outcomes among HIV infected persons in sub-Saharan Africa. This benefits from partnerships with the Centre for Infectious Diseases Research in Zambia (CIDRZ) and the London School of Hygiene and Tropical Medicine in Zambia and Tanzania. Nutritional Causes for Early ART Mortality in Zambia (NEMART, R21 AI 076430, D. Heimburger, PI), conducted at CIDRZ-supported public clinics in Zambia, investigated the complex metabolic abnormalities among HIV-infected adults with severe malnutrition and/or immunosuppression and predictors of early (i.e., <12 weeks) mortality on ART. NEMART was the first study to demonstrate low serum phosphate to be a strong predictor of early mortality on cART among low BMI adults, independent of other known risk factors, and served as critical preliminary data for a follow-up study of phosphorous supplementation to reduce mortality and morbidity in this population (NUSTART). The GH SWG is also studying the complex biochemical relationships between mitochondrial function, inflammation, iron metabolism, endocrine functions, and ART outcomes (NIMMA, D. Heimburger PI; W. Wester, J. Koethe and T. Hulgan co-investigators). This is a direct result of the CFAR process and productive interactions with the Human Genomics and HIV (HGH) Working Group of the Genomics Core led by Dr. Hulgan.
Insights from nutrition research in sub-Saharan Africa led to studies of immune reconstitution and inflammation among normal weight and obese adults enrolled in the Vanderbilt CCC, facilitated by the CFAR’s CDC (EOR WG and TRC WG) and institutional funding (J. Koethe, MD). This has extended to study of effects of adipokines on lymphocyte function and HIV replication. Future nutrition-related comparative clinical studies enrolling local and international participants are planned. This is an understudied area and the SWG will define contributions of nutrition to disparities between resource-limited and -replete regions.
Poverty and HIV outcomes
A third area of innovation is in studying relationships between outcomes of HIV infection and poverty / economic development, which provides a focus for future collaboration with the HD SWG and the Clinical Discovery Core’s Epidemiology and Outcomes Research Working Group. “Strengthening Communities through Integrated Programming” (SCIP) is a USAID and World Vision grant to VIGH, CFAR, and VU’s Owen School of Management (A. Vergara, PI, and L. Vaz, co-PI). SCIP supported the largest field research survey ever in Zambézia Province, Mozambique, where the VIGH PEPFAR grant serves 12 of 17 districts in the second most populous province in the country (population 4.1 million; 18% HIV seroprevalence). Faculty from the Owen School who are experts in economic development and the science of poverty alleviation (Dr. Bart Victor) joined this via a VIGH/CFAR outreach to the university that engineered these multidisciplinary research efforts.