November 4, 2005

VUMC, Meharry unite in fight against AIDS

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VUMC, Meharry unite in fight against AIDS

Vanderbilt University Medical Center and Meharry Medical College are uncovering clues to the disproportionate impact of AIDS on minorities and women in the United States.

Their findings — discussed this week during the second annual Nashville Community Health Disparities Summit — have implications for Nashville and for the developing world, which has the greatest burden of disease caused by the human immunodeficiency virus (HIV).

Recent research progress includes development of a microbicide-containing vaginal cream that may protect women from HIV infection, better understanding of the genetic, environmental and social factors that affect response to AIDS treatment, and advances in clinical studies.

David Haas, M.D., and his colleagues at Vanderbilt are identifying genetic variations, called polymorphisms, that affect the body's ability to break down anti-HIV drugs, and which may contribute to adverse drugs effects.

These findings may improve treatment, but they must be converted into action, urged Haas, principal investigator of the Vanderbilt AIDS Clinical Trials Unit.

“We're in the middle of the genomic revolution,” he said.

“It will be a travesty if we don't take this information and in some way translate it back to the bedside and to the community, to the global population to have a better impact on outcome.”

Translation is a goal of outcomes research conducted at the Nashville-based Comprehensive Care Center under the direction of Timothy Sterling, M.D., associate professor of Medicine at Vanderbilt. The center provides outpatient care to more than 2,000 HIV-infected patients.

“By looking at this large population and systematically studying outcomes, we're getting clues that are going to change how we manage patients,” said Richard D'Aquila, M.D., who directs the Vanderbilt-Meharry Center for AIDS Research.

For example, HIV attacks a type of white blood cell called the CD4 T cell. Measuring these cells as a percentage of total white blood cells, as well as the currently used absolute count of these cells, may help identify patients who would benefit most from early treatment, Sterling, Todd Hulgan, M.D., and their colleagues reported in the Sept. 15 issue of the Journal of Infectious Diseases.

If validated by further study, this finding could help countries make the most of expensive anti-HIV medications, Sterling added.

In the absence of a vaccine, it is crucial to pursue alternative ways of preventing HIV infection, said James Hildreth, M.D., Ph.D., who directs the Comprehensive Center for Health Disparities Research in HIV at Meharry.

Hildreth and colleagues at Meharry and Johns Hopkins University are developing a microbicide-containing vaginal cream that, in animal studies, effectively blocks HIV infection. They currently are seeking approval to begin tests in patients.

Steven Wakefield, community education director for the HIV Vaccine Trials Network, challenged researchers and community participants, including Nashville's Metropolitan Interdenominational Church, to partner more effectively to enhance clinical research and reduce AIDS disparities.

“These problems are not going to be solved without the participation of the black church,” Hildreth added.

If church leaders delivered messages about preventing HIV infection to their congregations, he said, “we could quickly get the word out.”