Study Compares Mortality Among People Entering HIV Care with General US Population

“HIV-related mortality has decreased since 1996 due to improving treatments and evolving care guidelines, but the extent to which persons entering HIV care have a higher risk for death over the following years, compared with peers in the general population, has been unclear.

Joseph Eron, MD, the Herman and Louise Smith Distinguished Professor of Medicine and chief of the division of infectious diseases, was the senior investigator on this novel observational study that advances the understanding of trends in mortality in the years after entering HIV care, compared with the general US population, published recently in the Annals of Internal Medicine.

The study was led by Jessie K. Edwards, PhD, assistant professor in the department of epidemiology, and utilized 13 sites from the North American AIDS Cohort Collaboration on Research and Design. Participants included 82,766 adults entering HIV clinical care between 1999 and 2017, and a subset of the US population, matched on calendar time, age, sex, race/ethnicity, and county using mortality and population data compiled by the National Center for Health Statistics.

The results showed a dramatic mortality decrease between 1999 and 2017, although those entering care remained at higher risk for death in the years after starting care than comparable adults in the general US population. Five-year mortality for people entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017.

“While we have seen substantial improvement in survival for people with HIV after they enter care, there is still a modest but real difference in survival compared to a carefully matched population of people without HIV,” Eron said. “Some of our patients still enter care years after infection and cannot take full advantage the improvements in treatment and care.”

Researchers acknowledge that understanding the differences in mortality between persons entering HIV care and the matched US population is critical to improving care, and that gaps still remain. Being able to quantify the elevation in mortality observed for persons in HIV care will inform future efforts to address both AIDS and non–AIDS-related consequences of HIV infection and long-term ART.

The study was supported by the National Institutes of Health; the Centers for Disease Control and Prevention; the Agency for Healthcare Research and Quality; the Health Resources and Services Administration; Grady Health System; the Canadian Institutes of Health Research; the Ontario Ministry of Health and Long-Term Care; and the Government of Alberta, Canada.”

This story was originally published by the UNC Department of Medicine on July 13, 2021 – read more here. 

Joseph Eron named to endowed chair

JE wearing white coat and maskUNC School of Medicine Dean Wesley Burks named Infectious Diseases Chief Joseph Eron, Jr., MD, the Herman and Louise Smith Distinguished Professor of Medicine on March 10, 2021. The honor acknowledges his decades-long commitment to infectious diseases along with his work this past year during the COVID-19 pandemic. We are honored to work with Dr. Eron, our CFAR Clinical Core Director!

Michael Hudgens Appointed Associate Chair of Biostatistics

Hudgens headshotMichael Hudgens, UNC CFAR Biostatistics Core Director, is the new Associate Chair of the Biostatistics Department! Dr. Hudgens joins Lisa LaVange, Department Chair, and brings many years of experience to UNC’s top-ranked biostatistics department. Hudgens has co-authored more than 200 peer-reviewed papers in statistical journals such as Biometrics, Biometrika, JASA and JRSS-B as well as biomedical journals such as the Lancet, Nature and New England Journal of Medicine. He currently serves as an Associate Editor for Biometrics, JASA and JRSS-B. He is an elected Fellow of the American Statistical Association and has taught graduate level biostatistics courses at UNC for over ten years. Congratulations!

Nature Highlights UNC HIV Research in ‘Best of’ List from 2020

Drs. Margolis, Garcia, and Dunham (left-to-right) pose in the Genetic Medicine Building

UNC-Chapel Hill HIV researchers David Margolis, MD, and J. Victor Garcia, PhD, along with Rick Dunham from ViiV Healthcare (from left to right). Margolis is director of the UNC HIV Cure Center, which is home to Qura Therapeutics, a company formed through a partnership between UNC-Chapel Hill and ViiV, formerly the HIV research wing of GSK.
Photographed January 21, 2020 at the Genetic Medicine Building on the campus of the University of North Carolina at Chapel Hill.
(Jon Gardiner/UNC-Chapel Hill)

UNC HIV researchers were featured in a recent Nature article titled, “Viruses, microscopy and fast radio bursts: 10 remarkable discoveries from 2020.” A study on HIV latency reversal from J. Victor Garcia, PhD, David Margolis, MD, and team (with Qura Therapeutics and Emory University) is listed as one of the 10 most remarkable discoveries of 2020!

Read more at the UNC Health and UNC School of Medicine Newsroom here. 

Gates Foundation awards UNC Global Women’s Health $6.2 million to study pregnancy outcomes in Zambia

UNC Global Women’s Health has received two new grants from the Bill and Melinda Gates Foundation for work on pregnancy outcomes in Zambia. The first grant funds the “Multi-omics for Mother and Infants (MOMI) Consortium,” which seeks to identify new predictive biomarkers for preterm birth, preeclampsia, stillbirth and fetal growth restriction. UNC Project-Zambia is one of six international sites to receive this funding. The second grant, “Antenatal-Postnatal Research Collective (ARC),” will expand UNC’s partnership with the University of Zambia to conduct prospective clinical research in pregnancy. The team will recruit 5,000 households in Lusaka into a community-based cohort and follow women from the preconceptional period through conception, gestation, delivery, and postpartum. Biological samples from the ARC cohort will be made available to the MOMI study, and participants enrolled in the ARC cohort will be offered participation in future interventional trials.

“The Bill and Melinda Gates Foundation has been critical to our pregnancy outcomes research in Zambia, and we could not be more grateful for this new support,” says Jeffrey Stringer, MD, FACOG, professor of obstetrics and gynecology and director of UNC Global Women’s Health. “Our group is committed to reducing the unacceptable burden of adverse birth outcomes faced by women living in the Global South. These new grants will support new research and further solidify our partnership with the University of Zambia.”

“This support from the Gates Foundation allows our partnership in Zambia to pursue exciting new innovations in pregnancy research,” says Myron Cohen, MD, director of UNC’s Institute for Global Health and Infectious Diseases. “We are grateful for the Foundation’s continuing support, which strengthens the Institute’s capacity as a leader in global women’s health.”

With these new awards, the Bill and Melinda Gates Foundation has invested $27 million in the UNC-Zambia site over the past 3 years. The team is also working on developing new technologies to bring obstetric ultrasound to the primary care level and to improve intrapartum monitoring of laboring women with wearable sensors. This portfolio of grants, combined with resources from the National Institutes of Health, UNC’s Center for AIDS Research, and the Institute for Global Health and Infectious Diseases, creates a world-class pregnancy research center working in a setting where adverse outcomes are common.”

These project are part of the UNC CFAR International Core efforts. Dr. Stringer is the Director of the the International Core, and Dr. Cohen is Associate Director of the CFAR and CFAR International Core. 

This story was originally published by the Institute for Global Health and Infectious Diseases on December 9, 2020. 

Three UNC faculty elected IDSA Fellows

Headshots of JK, AL, CHThe Infectious Diseases Society of America has elected Joseph Eron, MD; Anne Lachiewicz, MD, MPH; and Christopher Hurt, MD, to its latest group of Fellows of IDSA. This Fellowship in IDSA is the highest honor in the field of infectious diseases and is given to those who have achieved professional excellence and provided significant service to the profession. 

Eron is a professor of medicine, chief of UNC’s Division of Infectious Diseases, and a global leader in HIV research. He serves as vice chair and co-principal investigator of the AIDS Clinical Trials Group, the world’s largest and longest running HIV clinical trials network, and leads UNC’s AIDS Clinical Trials Unit with four sites in North Carolina, Malawi, and Vietnam. He directs the UNC CFAR Clinical Core. Lachiewicz is an associate professor of medicine, director of the Immunocompromised Host Fellowship Program, and infectious diseases specialist. Christopher Hurt is an associate professor of medicine, director of the North Carolina HIV Training and Education Center, and co-leader of UNC’s Center for AIDS Research’s PrEP Scientific Working Group.

Applicants for IDSA Fellowship are nominated by their peers and meet specified criteria that include continuing identification with the field of infectious diseases, national or regional recognition, and publication of their scholarly work. Nominees are reviewed and elected by the IDSA Board of Directors. Fellows of IDSA work in many different settings, including clinical practice, teaching, research, public health and health care administration.

See full list of new IDSA fellows here.

Read more at the IGHID website here. 

Tonia Poteat, PhD, featured as December 2020 SGM Health Researcher Spotlight

TP headshotDr. Tonia Poteat, PhD, MPH, PA-C, DFAAPA, is featured this month as the December 2020 SGM (Sexual & Gender Minority) Health Researcher Spotlight.

See below for highlights and read the full interview here on the SGMRO website. 

“Q: What organizational challenges have you faced?
A: As one of the earlier researchers in transgender health, it was initially hard to get funders to pay attention to the unique research needs of this community. I’m happy to see that has changed with time and lots of advocacy by many people over the years.

Q: What advice do you have for trainees and researchers who want to work in this area or are interested in applying for NIH funding?
A: I recommend always engaging and partnering with community members and/or community organizations. They can help guide your research so that you are addressing issues that really matter to the people most affected by them. As for NIH funding, finding mentors with experience writing NIH grants and time to provide detailed feedback is invaluable. And persist! It can take multiple submissions before you get funding, but if you believe in your project, don’t give up.

Q: Do you have any specific advice for working with and involving SGM populations in research?
A: Be trustworthy, dependable, and truly care about the people involved in your research studies. It will come through in your work and make it better.

Q: Who inspires you?
A: In the research world, I am deeply inspired by the work of Lisa Bowleg and the work of Nancy Krieger. In the non-research world, my mother inspires me to continue to grow and learn and do my part to build a better future.

The Sexual & Gender Minority Research Office (SGMRO) Researcher Spotlight web feature was launched in June 2020. These spotlights highlight both successful early and established NIH-funded investigators in the field of SGM health research. This feature is in an interview format, and explores pathways to and provides guidance for building a successful career in this field of inquiry.

Dr. Poteat is an Assistant Professor of Social Medicine at the University of North Carolina Chapel Hill (UNC), core faculty in the UNC Center for Health Equity Research, clinical preceptor for the Gender Affirming Clinic at UNC’s Student Health Action Coalition, and a Physician Assistant in the UNC Infectious Diseases Clinic. Her research, teaching, and clinical practice focus on HIV and LGBTQ health with particular attention to the role of intersectional stigma in driving health disparities.

Dr. Poteat previously served as a member of the Sexual and Gender Minority Research Working Group of the NIH Council of Councils.”

NIH Re-Funds ACTG for the Next Seven Years

The AIDS Clinical Trials Group (ACTG) Network has been re-funded for the next seven years by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). The ACTG is the largest global HIV research network. Dr. Joe Eron, UNC CFAR Clinical Core Director, is vice chair of the ACTG. 

“Founded in 1987, the ACTG was the first clinical trial network to focus on HIV. Its mission is to cure HIV and reduce the burden of disease due to HIV and its complications, including tuberculosis and viral hepatitis. Over the course of 2020, in addition to this work, ACTG has also been leading efforts to identify effective treatments for early COVID-19 by conducting the ACTIV-2 study.”

Read more from the ACTG Press Release here, published November 30, 2020. 

UNAIDS releases World AIDS Day report 2020 – Prevailing against pandemics by putting people at the centre

Five years after a global commitment to Fast-Track the HIV response and end AIDS by 2030, the world is off track. A promise to build on the momentum created in the first decade of the twenty-first century by front-loading investment and accelerating HIV service provision has been fulfilled by too few countries.

In [this] new report, UNAIDS is calling on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.”