A new center at Yale University“s medical school is set to focus on promoting healthy aging in patients living with HIV, backed by a five-year grant from the National Institute on Alcohol Abuse and Alcoholism. The center, named the Aging Well with HIV Through Alcohol Research and Risk Reduction and Education (AWAR3E), is spearheaded by a team that includes Amy Justice, a professor of internal medicine and public health, Julie Womack, an associate professor of nursing, and Vincent Lo Re, a professor of medicine and epidemiology at Rutgers University.
As advancements in therapy have allowed more individuals with HIV to live longer, the team aims to understand the increased risks of age-related medical conditions among these patients, including cancer, cardiovascular issues, liver disease, and diabetes. Justice stated, “We want to understand why that is both in terms of being able to help manage aging with HIV better, but also to gain insights into aging more generally.”
Justice highlighted that while both aging individuals and those with HIV often experience immune system challenges, the effects of HIV can be particularly severe. Many individuals with HIV continue to consume alcohol and may also face socioeconomic disadvantages, which could accelerate the aging process. The center”s research will delve into these contributing factors to inform future health interventions.
This initiative builds on the groundwork established by the Veterans Aging Cohort Study (VACS), which Justice originally founded to investigate the implications of alcohol consumption on aging in both HIV-positive and HIV-negative populations. VACS boasts over two decades of longitudinal data from a substantial number of individuals across the national electronic health record system.
The research team has dedicated years to mastering the interpretation of VACS data and has cultivated a network of experts in various relevant fields. Womack has focused her research on preventing falls and fractures in the aging HIV population, while the team includes specialists in liver disease, neurological disorders, cardiovascular health, and cancer.
Justice noted that her broader perspective as a general internist allows her to appreciate the expertise of her colleagues in more specialized fields. For Womack, a significant challenge was coordinating the grant writing process, which required the team to adhere to a strict timeline and conduct regular meetings to ensure that each draft aligned with their collective goals.
The grant writing process commenced in January 2024, with each team member contributing drafts that were collectively reviewed to enhance consistency. Despite the challenges, Womack expressed that collaborating with an interdisciplinary team has been rewarding, stating, “The opportunity to work with all these different people who have all these different interests and all these different lenses on the problem was just fascinating.”
The research is particularly focused on whether stressors such as alcohol use and socioeconomic deprivation lead to premature aging through mechanisms like inflammation. Justice emphasized that chronic inflammation is a significant factor in adverse aging outcomes for both HIV-positive and HIV-negative individuals. Factors such as obesity, poor diet, physical inactivity, substance use, and stress can all exacerbate chronic inflammation.
One specific project aims to investigate biological markers of stress and inflammation in individuals living with HIV. Even with effective treatment, some patients harbor low levels of the virus, termed viral reservoirs, and the study will examine whether these reservoirs contribute to stress and inflammation. Another project will explore the links between socioeconomic disadvantages and health issues related to aging, such as falls, fractures, dementia, and increased hospitalization rates.
Lo Re, speaking about the center”s objectives, emphasized the dual focus on research advancement and mentorship for emerging scientists. He stated, “One of the big benefits of our new center is that it will nurture the generation of significant research in alcohol-HIV/AIDS research.” Womack echoed the importance of disseminating findings from their projects, highlighting a core group dedicated to ensuring that results reach relevant audiences, including patients, clinicians, and organizations.
According to estimates from 2022 by the Centers for Disease Control and Prevention, around 1.2 million individuals in the United States are living with HIV.
