HIV and Cure

With the highest rate of new HIV diagnosis in the United States, South Florida is investigating key health issues associated with factors that make young women more vulnerable to HIV infection. Funded through the National Institute of Health, the University of Miami’s WHIMS examines the heightened risk of HIV and STI contraction faced by women with bacterial vaginosis (BV), the most common health condition affecting the female reproductive tract. 

Confronted with an increased risk of 40-60%, women with multiple episodes of BV are more vulnerable to HIV and may have lower efficacy of HIV prevention treatments. Using a comprehensive multidisciplinary approach, Dr. Maria Alcaide, MD and her collaborators are evaluating the behavioral, bacterial, and host biological factors that contribute to BV and its reoccurrence to develop targeted intervention to protect women from the poor health outcomes associated with BV, including HIV acquisition.

To learn more about this study click here or contact us at: 305-243-5435 or id.researchunit@miami.edu.

WHIMS has two locations:

UM/Jackson Memorial Hospital
ACC East Building
1611 NW 12th Ave
Miami, FL 33136

UM/Jackson Memorial Hospital
1800 NW 10th Ave. 
Miami, FL 33136

There are approximately 119,661 individuals living with HIV/AIDS in Florida (FLDH) and the epicenter for this epidemic is located right here in South Florida. The pursuit for a cure to HIV-I infection is one of the most challenging hurdles faced by the HIV/AIDS research community. Despite potent antiretroviral therapy (ART), HIV persists and rapidly rebounds if treatment to suppress the virus is interrupted. Understanding how HIV persists and in what form, is key to the development of effective strategies to eliminate infection. At the Stevenson Lab, Dr. Mario Stevenson, PhD, and top collaborators focus on developing novel therapeutic agents and studying peripheral reservoirs of HIV-1 replication. 
 
While antiretrovirals are being made available in many African countries, antiretroviral resistance is going unchecked and resistance testing, which guides treatment decisions in resource-rich settings, is not being implemented in resource –poor regions. To address this, we developed a cheap and simple, point-of-care assay for detection of HIV-1 drug resistance and secured STTR funding to bring this to implementation. We propose to exploit this same platform to develop a rapid and cost-effective assay for Zika Virus and for COVID-19 that would not require centralized testing facilities or specialized instrumentation. We believe that the cost and simplicity of this platform makes it attractive for implementation in under-resourced regions and additionally, in hospital labs and pre-natal clinics in resource-rich regions.

There are 1.1 million people living with HIV in the U.S. With $14 million in funding from the National Institute of Health, the Miami MWCCS is a collaborative research effort aimed at understanding and reducing the impact of chronic health conditions—including heart, lung, blood, and sleep (HLBS) disorders—that affect people living with HIV.

A national multicenter research effort, the Miami center’s seven-year project is led by principal investigators Dr. Margaret Fischl, MD, Dr. Deborah Jones Weiss, PhD, MD, and Dr. Maria Alcaide, MD. The study will follow 130 women, including 122 women who were followed under the Women’s Interagency HIV Study (WIHS), and 130 men with or at risk of HIV infection to understand the impact of chronic health conditions on those with HIV.

MWCCS

Nearly one quarter of the 1.1 million individuals living with HIV in the US are women, and yet there is a disproportionate impact on racial/ethnic minority women in the Southern US. Reproductive age women living with HIV (WLH) are highly affected by poor HIV outcomes, likely due to structural, psychosocial, and biological factors. Unfortunately, reproductive age WLH are grossly underrepresented in HIV research. However, the NIH-funded Study of Treatment and Reproductive Outcomes (STAR) Cohort is working to understand and address the effects of HIV and HIV treatment in this age group.  

With $15 million over the course of five years, the STAR Cohort will utilize the five Southern MACS/WIHS Combined Cohort Study sites to leverage the MWCCS structure and the scientific strength of the WIHS to integrate key thematic areas highly relevant for reproductive age WLH. Led by Principal Investigator Dr. Maria Alcaide, MD, the cohort will implement unifying multidisciplinary research to ultimately improve the health of young WLH, optimize the gains of ART, and contribute to ending HIV across populations in the United States.

Learn More

Aims

• Aim 1: To recruit and retain 2,000 reproductive age women living with HIV (WLH) representative of the Southern epidemic into a longitudinal cohort study to enable science in areas relevant to contemporary reproductive age WLH in a robust research platform.
  
  
• Aim 2: To assess the incidence and prevalence of depression by key sociodemographic and psychosocial factors, and individual and community-level social determinants of health, and its impact on HIV and reproductive health outcomes among reproductive age WLH. We will also use a novel statistical modeling approach to explore the potential impact of specific depression interventions on the same outcomes.
  
  
• Aim 3: To assess the effects of HIV factors, pregnancy, and social determinants of health on oral health; and determine if the biological changes (oral microbiota and inflammation) occurring in periodontal disease are associated with systemic inflammation and pregnancy outcomes among WLH. We will prospectively collect data and oral exams. In pregnant WLH, we will investigate the effects of periodontal disease, oral microbiota/ inflammation on systemic inflammation and pregnancy outcomes.

Led by Dr. Isabella Rosa-Cunha, Site PI, the ANCHOR study, or Anal Cancer/HSIL Outcomes Research Study, has halted new participant recruitment due to the therapy’s high success rates as of October 2021. 

ANCHOR has determined that treating precursor anal cancer lesions can considerably reduce the risk of progression to anal cancer among people living with HIV. The randomized clinical trial that included 4,446 participants is the first to show such findings and was performed at 21 clinical sites around the United States. The incidence of anal cancer is very high among people with HIV. The ANCHOR study will provide key information in guiding recommendations to make anal cancer prevention programs the standard of care for people at high risk of anal cancer. The study findings highlights years of research into the prevention and treatment of anal cancer and will set the standard for future care guidelines for high risk individuals. 

The Infectious Diseases Division participates in multiple studies to assess comorbities  associated with HIV positive patients and how best to treat these longterm health conditions, as well as establish beneficial training programs. The following is a list of related research by divisional faculty.

1. Randomized Trial to Prevent Vasular Events in HIV.

   Primary Investigator: Jose Castro, M.D.
   
   

2. Anal Dysplasia Clinic Pilot Program. Sub-study of the AIDS Malignancy Clinical Trails Consortium-University of Miami Core Site

   Primary Investigator: Isabella Rosa-Cunha, M.D.
   
   

3. UM CFAR SCCC Argentina Consortium for research and training in Virally Induced AIDS Malignancies

   Primary Investigator: Isabella Rosa-Cunha, M.D.
   
   

4. Viv Byen (Live Well): Telemedicne for HIV Care Among Haitian Americans

   Primary Investigator: Candice Sternberg, M.D.
   
   

5. Expansion of Rapid Antiretroviral Treatment in Miami Dade County for Improved Care Engagement
   Primary Investigator: Dr. Susanne Doblecki-Lewis