Mass General Brigham researchers are doing important work in the field of HIV/AIDS research.
December 1 marks the 35th commemoration of World AIDS Day, an annual event that reminds us that HIV and HIV-related stigma remain public health threats. Research and innovative treatments have helped drive progress over the last four decades of the HIV/AIDS epidemic, and ongoing research efforts are essential to continue making strides in prevention, treatment and, ultimately, toward a cure.
Researchers at Mass General Brigham are working on some of the most challenging problems and pressing questions related to HIV/AIDS. Check out some of our most recent research stories below.
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Finding HIV’s Hidden Reservoir Cells
Antiretroviral therapy (ART) has helped extend the lives of patients, but currently available treatment does not cure HIV infection. The virus persists lifelong, and antiviral drugs need to be taken indefinitely to suppress the virus. HIV-1 reservoir cells – infected cells that are highly durable – are one of the reasons HIV remains so difficult to cure since these cells cannot be eliminated by currently available antiretroviral agents. While the cells may not actively produce new copies of the virus, they give HIV a safe harbor in which to hide, potentially for years, and become active again.
Mathias Lichterfeld, MD, PhD, is a member of the Ragon Institute of Massachusetts General Hospital, MIT and Harvard and a staff physician in the Infectious Disease Division at Brigham and Women’s Hospital. The Lichterfeld lab studies samples from patients with HIV to learn about HIV-1 reservoir cells and pinpoint their vulnerabilities.
Some individuals taking ART continue to have low levels of viral presence in the bloodstream, or viremia. This condition is usually attributed to drug resistance or ineffectiveness of ART, but recent studies have found that low-level viremia can occur even without these driving forces, a condition known as non-suppressible HIV viremia (NSV). Brigham and Women’s Hospital infectious disease physician-scientist Jonathan Li, MD, and colleagues recently found proviruses — viral genetic material that has been integrated into host DNA — inserted into transcriptionally active regions of immune cell genomes in patients with HIV. Although unable to replicate due to ART, these proviruses contained mutations that helped them evade detection. Understanding these mechanisms could help researchers develop strategies to disrupt viral persistence.
Brigham and Women’s Hospital infectious disease physician-scientist Shahin Lockman, MD, has led clinical research and training related to HIV-1 in Botswana since 1996. One of her areas of research focus is studying HIV treatments during pregnancy and breastfeeding to identify regimens that optimize maternal and child health outcomes. Pregnant and breastfeeding women are often left out of clinical research on new drugs and are therefore frequently prescribed older, less effective drugs or may receive drugs for which pregnancy safety data are lacking. Lockman is also working with the World Health Organization and other stakeholders to advance strategies to accelerate ethical research on new drugs during pregnancy and breastfeeding to prevent or treat HIV and other infections.
Paul Sax, MD, is the clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, and is Editor-in-Chief of Clinical Infectious Diseases, the flagship journal of the Infectious Diseases Society of America. He is also a regular writer for NEJM Journal Watch, where his “HIV and ID Observations” blog covers HIV, other infectious diseases, medicine in general, and various not-so-medical topics. Sax summarizes HIV-related studies, making them accessible not only to fellow physicians but to a wide audience interested in the latest news on treatment, prevention and more. His writing has generated more than 2 million page views and 3,500 comments, with readers from all over the world. Sax is also actively involved in research, clinical practice and teaching.
Reducing Risk of Cardiovascular Events for People Living with HIV
The risk of cardiovascular disease, including heart attack and stroke, has been shown to be roughly twice as high in people living with HIV than the general population.
The recent large-scale randomized REPRIEVE trial led by Massachusetts General Hospital’s Steven K. Grinspoon, MD,found that daily statin use by HIV positive participants reduced their risk of experiencing a major adverse cardiovascular event (MACE) by 35% in comparison to the control group. Statin use also reduced the risk of MACE-related deaths by 20%. These positive impacts were so significant that the trial was halted early for efficacy.
The Life-Saving Benefits of a Daily HIV Prevention Pill for Young Men Who Have Sex with Men
About one in five new HIV diagnoses in the United States occur among youths ages 13 to 24 years. Young men who have sex with men (YMSM) accounted for 81% of new diagnoses in this age group in 2019.
When taken daily as prescribed, oral preexposure prophylaxis (PrEP) medication reduces the risk of sexually acquiring HIV by about 99%.
In a recent modeling study, Anne Neilan, MD, MPH, a physician investigator in the Division of Infectious Diseases at Massachusetts General Hospital, led a team that compared the cost and clinical effectiveness of providing daily generic PrEP medication to YSSM compared to annual HIV screening alone.
The model projected that over 10 years, daily generic PrEP treatment would reduce new HIV acquisitions from 37% to 30% and decrease costs by $5,000 per person, compared to annual screening.
These findings held up across several scenarios, including a range of drug prices, HIV incidence rates, and treatment retention rates.
Impacting Population Health Through Community-Based HIV Care in South Africa
A 2020 study led by Ruanne Barnabas, MD, chief of the Division of Infectious Diseases at Massachusetts General Hospital, showed that providing community-based HIV care (compared to clinic-based care) in South Africa and Uganda could improve outcomes and reduce costs.
In a recent follow-up study, Barnabas and team used health economics modeling analyses to project that by 2060, scaled-up community-based HIV care could avert 28% of HIV-associated deaths and new infections in these hard-hit countries.
Because more men would be likely to access treatment that controls their infection in the community-based model, adolescent girls and young women aged 15-24 would see the greatest overall benefit in risk reduction, with a projected 31% reduction in new HIV infections, the researchers found.
Universal T Cell Vaccine Work Recognized by National Institute on Drug Abuse
Gaurav Gaiha, MD, DPhil, a physician investigator from Massachusetts General Hospital and the Ragon Institute of Mass General, Harvard and MIT has been awarded a prestigious Avant-Garde Award for HIV and Substance Use Disorder Research from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). This award is part of the NIH Director’s Pioneer Award mechanism which supports individual scientists of exceptional creativity who propose high-impact research that will open new areas of HIV research and/or lead to new avenues for prevention and treatment of HIV among people who use drugs.
Gaiha received this award for his project, “Harnessing Highly Networked HLA-E-Restricted CTL Epitopes to Achieve a Broadly Effective HIV Cure,” which aims to create a universal T cell vaccine for HIV.
