HIV Research of the Nutrition/Infection Unit
Early Boston Research
When we began our research in 1994, the major nutritional problems facing people with HIV were weight loss and wasting. Our research centered on possible contributing factors such as gastrointestinal malabsorption, diarrhea, and increased metabolism, as well as symptoms including nausea, fatigue, and lack of appetite. We also investigated micronutrient levels and the safety and effectiveness of exercise to build lean body mass.
New Treatments, New Questions
As new medications became rapidly and widely used in combination antiretroviral therapy, patient outcomes improved dramatically – and new issues emerged. HIV lipodystrophy – the syndrome of subcutaneous fat loss, visceral fat gain, insulin resistance and abnormal lipid metabolism – along with cardiovascular disease risk, bone loss, and liver disease are among the complications now under investigation. We are also examining the use of interventions such as diet, exercise, and medication.
Expanding Our Community
Within a few years, our studies reached large and broad segments of HIV-affected populations in the Boston area. In 1999 we were able to expand our research to the previously under-served Hispanic community. The Bienestar study – conducted entirely in Spanish – is exploring nutritional status in Hispanic, HIV-positive and HIV-negative, drug users and non-drug users. With the establishment of the Tufts Nutrition Collaborative (TNC-CDAAR) and the launch of the TNC Study in 3 U.S. cities and 3 overseas locations, we are further investigating the impact of drug abuse on nutrition and metabolism in HIV, issues that have rarely been investigated either in the U.S. or abroad.
A Global Endeavor
Access to antiretroviral therapy in the developing world has been acutely delayed. As it arrives, however, it is being implemented in a more standardized way than it was in the developed world, raising important research questions before, during, and after its rollout. As we continue our work in Boston, we are forging research connections around the world, in countries such as India, Vietnam, Kenya, Namibia and Ghana. So now we ask: What lessons learned at home and abroad can we apply to facilitate and optimize wider treatment in resource-limited settings? Which treatment and monitoring strategies can help to reduce morbidity and mortality, as well as avoid negative nutritional and metabolic outcomes? What role does food insecurity play in medical outcomes in persons living with HIV? We and our research partners overseas will have much to learn from each other in the years to come.