The Aminu Kano Teaching Hospital (AKTH) and Vanderbilt Institute for Global Health (VIGH) are conducting a research study in northern Nigeria to investigate cardiometabolic disease risk and the metabolic mechanisms behind weight gain in people with HIV, newly treated with antiretroviral therapy (ART).
“Understanding why some individuals experience weight gain beyond a normal ‘return to health’ is critical to enabling earlier, targeted interventions,” said VIGH Director Muktar Aliyu, MBBS, DrPH, professor of Health Policy and Medicine. “Identifying patients at highest risk will enable safer, more personalized care and better long-term outcomes.”
Weight gain following initiation of integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is a major emerging public health threat, significantly increasing risks for dyslipidemia (unhealthy levels of fat in the blood), systemic inflammation, hypertension, diabetes and cardiovascular disease among people with HIV in both the United States and globally.
“As individuals can now survive decades on modern treatment regimens, there is an increasing focus on preventing cardiometabolic conditions to ensure that people with HIV live not just longer, but healthier, lives at home and around the world,” added John Koethe, MD, professor of Medicine in the Vanderbilt Health Division of Infectious Diseases.
The increase in HIV diagnoses in Nigeria, combined with the widespread use of a standard regimen of tenofovir disoproxil fumarate, lamivudine, and dolutegravir (referred to as TLD), offers a consistent treatment setting for the study. This uniformity allows researchers to more clearly identify biological changes linked to weight gain after starting ART.
Leveraging its expanding non-communicable disease and HIV research portfolio in northern Nigeria, the team also plans to build local capacity in omics analysis, in addition to establishing new South-South collaborations (a term describing the exchange of resources, technology and knowledge between developing countries) with other academic institutions engaged in cardiometabolic research.
In the first phase of the study, researchers will examine how significant early weight gain while on standard TLD affects insulin resistance, blood pressure, dyslipidemia and inflammation. They will enroll 200 patients who were ART-naïve and divide them into two groups of 100 based on weight gain: those with less than a 3% increase and those with more than a 10% increase during their first 12–24 months of therapy.
In phase two, researchers will enroll and follow 60 ART-naïve adults, collecting sociodemographic, behavioral, clinical, metabolomic and lipidomic data to characterize their health and metabolism. Abdominal CT scans will help assess visceral adiposity and liver density, allowing researchers to observe how weight fluctuations during treatment affect carbohydrate and lipid metabolism.
Analysis of changes in metabolism and lipid levels associated with weight gain in TLD-treated patients during their first year may inform how diagnostic tools and treatment protocols could help clinicians predict and prevent harmful weight gain earlier in patients’ care.
Aliyu, C. William (Bill) Wester, MD, MPH, professor of Medicine in the Vanderbilt Health Division of Infectious Diseases, Koethe, and Aminu Abba, MBBS, MSc, FMCPath, Deputy Director of Research and Training at the Center for Infectious Diseases Research at Bayero University Kano and attending physician at AKTH, are the principal investigators.
The project is supported by the Fogarty International Center of the National Institutes of Health (R21TW012835).
