Let’s set the scene: it was a cold icy and snowy week in March when the ‘Beast from the East’ rolled into town to cause havoc. Luckily for me, I just had to get across London to Heathrow for a 6.5 hour flight to Boston; what could be simpler? Nothing, as it goes – the roads were clear and we even took off early. I touched down in Boston, jumped on the subway, found the hotel and I was “all-set”! It was very windy as I’d arrived in time to catch the tail-end of a Nor’Easter storm. This one had seen the National Guard called in to rescue stranded residents, the Fire Department even airlifted a horse from a field, and the aquarium, of all places, flooded!
Boston was playing host to the 25th CROI (conference on retroviruses and opportunistic infections), which was my first international HIV meeting. I won a New Investigator Scholarship which covered my travel and registration but also granted me access to the New Investigator Workshop. As a new researcher in the field of HIV, this proved to be a fascinating whistle-stop tour of the essentials in the field.
Women don’t get AIDS, they just die from it
The workshop kicked off with a world premiere of the viral lifecycle, expertly animated and narrated by Dr Janet Iwasa (check it out for yourself at www.scienceofhiv.org). We were also given overviews of the hot topics to be discussed over the next few days. This included advances in HIV treatment, care and prevention and the molecular virology of the disease. We were told about advances in tuberculosis (T.B.) treatment and prevention, an area that we are expanding into. There were too many cool innovations to do justice in one blog, so I will stick to my personal highlights.
A stand-out moment for me was the Martin Delaney presentation entitled “Women in research: science is better when women are represented”. In this session we heard from inspirational researchers and activists: Proessor Gandhi, Dr Poteat and the founder of SisterLove, Dázon Dixon Diallo. Talks highlighted the challenges faced by women in academia, where (un)conscious bias means that only 16% of Deans and 22% of full professors in US institutions are female. Professor Gandhi demonstrated how formalised career mentoring could go some way to improve this imbalance. Another interesting statistic shared was that despite more than half of HIV infections being in women, they make up less than 15% of the participants in clinical trials. To highlight this bias, CROI stipulated that all presentations of clinical data must show sex-stratified results, where possible. It was also revealed that this CROI was the first time that there were more female than male speakers – a step in the right direction!
Dr Poteat told us about her journey from being a HIV activist in the 1980’s, working with Act-Up (Atlanta) as a physician’s assistant and completing her PhD at Johns Hopkins University in 2012. She now researches issues around sexuality, gender identity, stigma and how these impact on HIV infection rates and transmission. Dázon gave a blow-by-blow account of the brave activists that stood up to make sure that women were included, seen and recognised during the HIV epidemic. This work is far from over and she encouraged us to think about ‘proximity’, ‘get uncomfortable’, ‘change the narrative’ and improve links between the community and research.
HIV increases cardiovascular risk
Our Platelet Biology Group is interested in the role that these small cells play in heart disease and how other diseases (e.g. HIV) and environmental factors (e.g. pollution) can alter platelet activation. Improvements in the diagnosis, management and treatment regimens for HIV mean that people living with HIV (PLWH) have near-normal life expectancies. Consequently, studies have shown an increased rate of heart disease in PLWH and that certain antiretroviral therapies can increase this risk further. This increase accounts for around 10% of cases and clearly warrants further investigation. We received funding from Gilead Sciences and St Stephen’s AIDS Trust to investigate this link between antiretroviral therapies and heart disease. This is a controversial topic and conflicting reports have come from a range of groups investigating the effects of antiretroviral therapies on platelet function. I presented my latest data on the pharmacological impact of antiretroviral therapies on platelet function. This was a fantastic opportunity to discuss our findings with other researchers and clinicians and discuss what the data might mean in the wider population. It was good to see other work in this area, which suggested roles for immune cells, the vessel wall and specific signalling pathways in the development of heart disease in PLWH.
TB causes one million more deaths per year than HIV
Two billion people are carriers of TB and most will never go on to develop the disease. However, seven million cases per year are diagnosed and treatment takes around six months. TB is also a common co-infection for people living with HIV (PLWH). This raises an interesting challenge as TB drugs cause HIV therapies to be metabolised more quickly. This means that patients must take double doses of HIV medication to maintain viral suppression. However, a late-breaking abstract from our collaborators at St Stephen’s AIDS Trust demonstrated that a newly formulated HIV drug might be able to bypass this effect. This could lead to a change in the management of TB co-infections.
The “U equals U” (Undetectable = Untransmissible) campaign launched in 2017 and serves to educate the public about the fact that people with undetectable levels of HIV cannot transmit the virus. This is an important development as reducing stigma associated with HIV improves patient adherence to therapy. This could be a key step in the aspiration to reach no new HIV infections by 2030!
Research associate at the National, Heart and Lung Institute.
Follow on Twitter @Dr_KTaylor