Editor’s Note: We’re pleased to present this guest blog by Pablo Tebas, MD, the Principal Investigator at the University of Pennsylvania HIV Clinical Trials Unit – a leading research facility involved in the search for a cure for HIV infection. This is the second of a series of two blog posts about significant research initiatives at Penn, which present opportunities for HIV-positive individuals to participate.
The treatment of HIV infection has improved dramatically over the last decade. The new antiretroviral medicines are better tolerated, have less toxicity, and are easier to take because they are frequently combined in single tablet regimens. However, the situation is far from perfect. Patients with HIV infection have to take drugs every day, and they have to visit their doctors frequently. In spite of having undetectable HIV viral loads, they continue to have health problems with more frequency than the general population.
Patients with HIV infection, in spite of doing well on their meds, tend to have more cardiovascular events (myocardial infarctions), osteopenia and osteoporosis, diabetes, neurocognitive impairment, and cancers than the general population. Some people even think that patients with HIV infection are aging faster than people without HIV. We still do not have a clear understanding of why this is happening. We think that persistent inflammation has something to do with it.
When we compare patients with HIV infection who are doing well on their HIV meds with similar individuals who do not have HIV infection, the HIV-positive individuals tend to have higher levels of markers of chronic inflammation. We know that in other diseases like rheumatoid arthritis, psoriasis, inflammatory bowel diseases, and others, this persistent inflammation is associated with the type of complications that we are seeing in patients with well-controlled HIV replication. That is why we think chronic inflammation is not good for patients with HIV infection, and we are trying to figure out ways to fix it.
The University of Pennsylvania is evaluating treatments, some of them used for other indications, to treat this persistent inflammation. We have two studies.
The first is evaluating the use of a cholesterol-lowering drug (a statin) to treat this persistent inflammation. We know that when we lower the cholesterol levels we decrease the risk of cardiovascular events, even in people with normal cholesterol. The goal of this study is to see if these decreases in cholesterol are associated with decreases in inflammation. Because many people are taking these medicines, we know that they are reasonably safe, and if we prove that they are effective in reducing inflammation, we may use them in the population of patients living with HIV.
In the second study, we use an anti-inflammatory drug called methotrexate. This is a very potent anti-inflammatory drug that is used to treat rheumatoid arthritis and other inflammatory diseases. We want to see if, by using low dose methotrexate, we can decrease inflammationand improve the way your cardiovascular system responds using a brachial ultrasound. This test evaluates cardiovascular risk, and we think this drug, if it works, will decrease the long-term cardiovascular risk of patients with HIV infection.
For more information about participation, please contact Joseph Quinn, RN, or one of the research nurses at 215-349-8091.
–Pablo Tebas, MD, Principal Investigator, University of Pennsylvania HIV Clinical Trials Unit