Our Strategic Plan focused our CFAR on supporting an overarching goal of developing new approaches to prevent new HIV infections. To drive research by CFAR investigators to achieve this goal while stimulating new creative and interdisciplinary approaches, we established three Research Programs. These three Research Programs were developed because the critical mass of senior and junior investigators engaged in basic translational and clinical research in these particular areas provided major opportunities for synergism, interdisciplinary interactions, new collaborations and program growth. To encourage the active participation of early stage investigators, each Research Program is co-directed by a senior investigator and an early stage investigator (ESI). The Programs hold monthly meetings. All interested investigators are invited to join and can obtain further information by contacting one of the Research Program Co-directors.
Substance Abuse & HIV Transmission
Co-directed by Drs. Julia Arnsten and Aaron Fox, this Research Program is focused on determining mechanisms by which substance abuse facilitates HIV transmission and how to optimize HIV prevention and treatment in individuals who are illicit drug users. Illicit drug use is a major driver of HIV acquisition and transmission in our Bronx community which is particularly challenged by socioeconomic difficulties and substance abuse. Illicit use of drugs such as opioids, cocaine or methamphetamine (meth) are well-established risk-factors for HIV infection due to their association with high-risk behavior (i.e., increased promiscuity and decreased antiretroviral therapy (ART) adherence) that increases the likelihood of HIV transmission and acquisition and the direct effect of substance abuse on compromising host immunity and facilitating HIV replication. Recent studies indicate that early identification and enrollment of HIV-infected individuals in an ART program reduces HIV transmission by decreasing plasma HIV-RNA levels, reducing risk behaviors, and initiating pre-exposure ART prophylaxis (PrEP) for at-risk individuals may prevent infection with HIV. A highly interactive and interdisciplinary group of Einstein investigators is investigating and optimizing implementation of these and other approaches to improve the capacity to prevent, diagnose and treat HIV infection in individuals for whom substance abuse is the leading risk factor for HIV-infection.
HIV Transmission to Women
Co-directed by Drs. Betsy Herold and Rebecca Madan, this Research Program is focused on identifying factors unique to the pathogenesis, prevention, treatment and course of HIV infection in women. In studies relevant to the large population of HIV-infected women in the Bronx population, this Research Program synergizes with the Einstein WIHS program and seeks to identify factors relevant to unique mechanisms related to HIV transmission to women with a goal of developing new approaches to prevent HIV infection in women. Approximately half of HIV-infected individuals worldwide are women who were predominantly infected by sexual transmission or illicit drug use. A wide array of biological, behavioral, and structural factors intersect to uniquely affect the acquisition and prevention of HIV infection in women. Increasing our understanding of the cellular and molecular mechanisms associated with the acquisition of HIV in the female genital tract should enable the rational design of strategies (oral and topical PrEP, vaccines, behavior, new forms of contraception) to prevent HIV and STI, and the identification of factors that uniquely impact on the clinical course of HIV infection in women. The Einstein-Montefiore CFAR plays a crucial role in stimulating and supporting studies of this multi-disciplinary and highly interactive group of NIH-funded senior and junior basic, translational and clinical investigators which has been greatly expanded by CFAR supported recruitments in the past 5 years.
HIV and Mtb Co-infection
Co-directed by Drs. William Jacobs and James Brust, this Research Program is focused on delineating the pathogenic interactions between HIV and TB that impact on HIV transmission, diagnosis, treatment and disease morbidity and mortality. In studies relevant to a major public health concern identified as a priority research area by the NIH and the Federal TB Task Force, this Research Program group is delineating the pathogenic interactions between HIV and Mycobacterium tuberculosis (Mtb) that impact HIV transmission, vaccine efficacy, diagnosis, treatment and disease course. HIV infection is the strongest risk factor for developing tuberculosis and Mtb is the most common opportunistic infection and the leading cause of mortality in HIV-infected individuals with an estimated 12 million individuals worldwide co-infected with HIV and Mtb. Synergistic interactions between HIV and Mtb in co-infected individuals likely impact the transmission, pathogenesis, disease course and treatment response mediated by each pathogen and accelerate the emergence of more lethal drug-resistant MDR and XDR strains. Improved diagnosis and treatment of Mtb is likely to improve the diagnosis, treatment and prevention of HIV infection. Studies in this program range from the bench to the bedside and include research delineating the mechanisms underlying the pathogenic interactions between HIV, TB and the immune system, development of Mtb vaccines and increasing our capacity to diagnose and treat MDR and XDR Mtb infections in HIV/AIDS patients.
The overarching goal of our Scientific Working Groups (SWG) is to drive interdisciplinary research among investigators with expertise in scientific disciplines ranging from basic science to behavioral, epidemiological and clinical research, many of whom have not previously collaborated on scientific endeavors. We also use the SWGs as a forum to support career development by early stage investigators (ESIs). During the Strategic Planning process and CFAR member survey, we identified two areas of excellence in which we have a critical number of researchers to form a SWG to focus on significant HIV/AIDS research directions relevant to the overarching Aim of our CFAR, which is to prevent new infections; (1) Neurocognitive Impact of HIV and Illicit Drug Use, and (2) HIV Vaccine Development. These SWGs share common specific aims to facilitate synergy among diverse investigators, to develop and drive new highly interdisciplinary projects focused on investigators’ designated area of excellence and to support education, training and mentoring.
Neurocognitive Impact of HIV and Illicit Drug Use
This Scientific Working Group (SWG) is co-directed by Drs. John Foxe and Chinazo Cunningham and is focused on utilizing cutting-edge neuroimaging approaches to delineate the combined impact of HIV and illicit drug use on cognitive function. Up to 50% of HIV infected individuals develop measurable HIV-associated neurocognitive disorders indicating that effective antiretroviral therapy (ART) does not prevent the development of chronic CNS neuroinflammation. HIV infection is often associated with illicit drug use, which affects cognitive function, increases risky behavior and decreases ART adherence. The additive impairment of cognitive function due to the combined negative impact of HIV infection and illicit drug use likely increases high risk behavior and reduces ART adherence, thereby increasing HIV transmission/acquisition in this population. The goals of this SWG are to generate synergy to study the neurocognitive impact of concomitant HIV and illicit drug use by bringing together an interdisciplinary group of investigators with expertise in HIV, substance use, neuroimaging, and neurology; identify collaborative opportunities that will apply cutting-edge neuroimaging techniques to provide new insights into our understanding of the mechanism of the combined impact of HIV and illicit drug use on the brain; and encourage ESIs to extend their research to application of advanced neurocognitive study methods to study the impacts of HIV and illicit drug use on cognition.
HIV Vaccine Development
This Scientific Working Group (SWG) is co-directed by Drs. Gregoire Lauvau and Michelle Larsen and is focused on utilizing novel approaches to develop HIV vaccines that will provide efficient and cost-effective prevention of HIV infection. The complex biology of HIV, the lack of understanding of correlates of protection, and the ability of HIV to cause latent infection represent major reasons why effective vaccines against HIV remains an elusive goal. This SWG focuses on generating synergy to develop HIV vaccines by building an interdisciplinary core group of investigators with expertise in HIV, vaccinology, immunology, microbial pathogenesis, systems and computational biology and bioinformatics; applying novel immunogenic TB mutants as a HIV vaccine vector identifying opportunities for collaboration between researchers from various disciplines with a common goal of producing effective HIV vaccines; and recruiting ESIs to initiate programs relevant to the development of HIV vaccines.