Complications of HIV Disease and its Therapy
With the advent of more effective antiretroviral therapy, persons infected with HIV are living longer. As a result, clinicians are paying increased attention to long-term toxicities of antiretroviral therapy and chronic liver disease in this patient population.
A major focus of my clinical research effort has been the investigation of metabolic complications in HIV-infected patients, including lipid elevations that may predispose to accelerated cardiovascular disease, body shape changes known as lipodystrophy, and disorders of glucose metabolism. We are conducting epidemiological studies and clinical trials in this area. The clinical trials are conducted in the Cornell Clinical Trials Unit, which I co-direct, and are sponsored by the NIH's Adult AIDS Clinical Trials Group (ACTG), the National Institute of Diabetes and Digestive and Kidney Diseases, and the pharmaceutical industry. Recently completed and ongoing projects include: case-control studies of diabetes mellitus and osteonecrosis; clinical trials of lipid-lowering agents; a pharmacokinetic study of calcium channel blockers and HIV protease inhibitors; and, a clinical trial investigating the effects of recombinant human growth hormone and/or rosiglitazone for treatment of the increased visceral fat component of the lipodystrophy syndrome in HIV-infected patients.
In the area of liver disease, we have been testing novel approaches to therapy of HCV/HIV co-infection, including treatment of insulin resistance prior to re-treatment of prior non-responders to standard HCV therapy through an ACTG-sponsored trial.
We have also been investigating various aspects of HIV disease through the NIH-sponsored Women's Interagency HIV Study, a multicenter prospective cohort study of women with and at risk for HIV infection. Completed projects include investigations of the epidemiology of herpes zoster (shingles) and risk factors for poor immunologic responses to antiretroviral therapy in HIV-infected women. We are presently investigating novel cardiovascular risk factors in this cohort.
In addition, I collaborate with researchers at the Federal University of Bahia in Salvador, Brazil in epidemiological studies of HTLV-I and clinical trials of cutaneous leishmaniasis.