Chicago WIHS Concept Sheets and Substudies

Bone loss and fat gain are common conditions in people living with HIV. The current proposal seeks to understand whether these two conditions are linked and whether the link is the same in men and women. We will also measure blood proteins to see whether they contribute to bone loss and body fat changes. We believe that finding the proteins that are most likely involved can help develop new treatments to prevent bone loss and fat gain.Low bone mass and sarcopenia as risk factors for skeletal fractures – Ryan Ross

People living with HIV are at higher risk of bone fractures. However, the reason why remains unclear. How fractures are predicted in people without HIV do not work as well in people with HIV. Our research will explore whether changes in muscle strength or bone structure contribute to the increased likelihood of bone fractures in individuals with HIV. 

The Contribution of Sleep and Circadian Disruption to Kynurenine Pathway Activation and Cardiometabolic Risk in Women with HIV – Audrey French, Helen Burgess, Kathleen Weber

Medical research has shown that poor or disrupted sleep patterns can lead to health problems, such as cardiovascular diseases. People with HIV are at higher risk of these diseases as well. Some initial findings suggest that sleep disturbance can increase the risk of cardiovascular issues by promoting inflammation. We aim to investigate the extent of sleep disruption in WIHS women and determine whether it is affected by HIV status. Additionally, we will examine the impact of sleep quality on the IDO pathway, which has been associated with cardiovascular disease.

Bone and fat measures in Chicago MWCCS midlife women with and without HIV – Ryan Ross

Treatments for HIV have been linked to osteoporosis. Newer medicines do not appear to cause as many bone problems. We want to investigate bone health in women taking these newer, less bone-toxic medicines. We will perform X-ray imaging to evaluate bone health and also determine whether a portable and simple instrument called Ultrascan can perform as well as X-ray to measure bone mineral density.

Musculoskeletal pain in Chicago MWCCS women – Ryan Ross

As people age, muscle and joint pain become more common. Muscle and joint pain may affect people living with HIV more than people without HIV. We will ask women with and without HIV how much joint pain affects their daily lives and how much pain they experience to determine how much joint pain affects daily activities.

Sleep/circadian disruption and kynurenine pathway activation:  a comorbidity risk for midlife men and women living with HIV? – Audrey French

It has become ever more clear that sleep is essential for maintaining good health and that any disturbance in sleep can lead to poor health outcomes. Recently, we found that among 300 women, activation of a certain inflammatory pathway (the tryptophan-kynurenine pathway) was associated with more fragmented and poorer sleep among HIV-infected women, but not among HIV-uninfected women. This pathway has also been associated with poor heart health. We want to use existing samples to confirm these findings by testing specimens from the men who had sleep studies in the former MACS and comparing HIV infected to uninfected men and also men to women. We will look at the activation of the pathway and its relationship to sleep quality, sleep quantity, and sleep variability (circadian timing).

Mineral Metabolism and Osteosarcopenia in People Living with HIV (PLWH) – Ryan Ross

Bone and muscle mass both decline with age and there is reason to believe that these two conditions are linked. The current study will investigate the link between these two conditions to determine which is more common in the HIV population and which occurs first. We will also investigate whether calcium and phosphate metabolism is driving the two conditions.

Sex differences in bone-fat crosstalk – Ryan Ross

Bone loss and fat gain are common conditions in people living with HIV. The current proposal seeks to understand whether these two conditions are linked and whether the link is the same in men and women. We will also measure blood proteins to see whether they contribute to bone loss and body fat changes. We believe that finding the proteins that are most likely involved can help develop new treatments to prevent bone loss and fat gain.

The effects of antiretrovirals on bone-fat hormonal crosstalk – Ryan Ross

The treatments for HIV have been reported to cause both bone loss and metabolic syndrome, which includes fat gain. New treatments appear to cause less bone loss but are worse for metabolic syndrome. We believe that this is due to changes in hormones that are produced by bone and fat. We propose to determine whether people who switch to new treatments show changes in their hormone levels and whether the hormones lead to metabolic syndrome.

Prevalence and correlates of poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) in MWCCS – Kathleen Weber

HIV infection can directly and indirectly lead to poor sleep quality. Disturbances in sleep have been associated with systemic inflammation and worsening of many medical and mental health problems including mood and anxiety disorders, cognitive dysfunction, and cardiometabolic conditions. Individuals living with HIV are also at higher risk for these same conditions that may cause poor sleep. We are trying to understand sleep quality and the extent that sleep disturbances occur in men and women and whether this is influenced by HIV and other factors. We will examine the association between measures of sleep quality, mental health, cognition, and markers of cardiovascular and metabolic disease risk. We plan to start by using an easy-to-administer but well-validated self-report questionnaire called the Pittsburgh Sleep Quality Index or PSQI.

Neighborhoods, chronic stress, and CVD risk among women with HIV in Chicago WIHS – Kathleen Weber

Women living with HIV (WLWH) are reaching older age due to enhancements in antiretroviral medications and improved access and quality of care. Additional chronic diseases often impact women with HIV as they age, such as cardiovascular diseases. To meet the complex needs of women aging with HIV, it is important to understand various factors that contribute to cardiovascular disease risk. The purpose of this study is to examine the relationship between how women with HIV perceive aspects of their neighborhood that may be associated with heart health. Longer term cardiovascular disease will be measured with the Framingham Risk Score. If there is an association between perception of neighborhood environment and the FRS, we will determine whether this varies by cortisol levels in hair, a good biomarker of chronic stress.

Patient-engaged approach to addressing depressive symptoms – Kathleen Weber

During each WIHS visit, interviewers ask women about specific symptoms related to depression using a validated 20-item screening instrument for depression, the Center for Epidemiologic Studies-Depression (CESD). Depressive symptom burden is high in WIHS. Reports confirm that a CES-D total score of 16 or greater can predict depression even in HIV infected individuals and is associated with poor medication adherence, higher HIV viral load, increased cardiometabolic risk, frailty, and even death. In the past, we have not shared CES-D
scores with women or their providers. We will now do computerized scoring at the WIHS visit so that we can identify women with scores of 16 or greater, highlight significant symptoms, and encourage women to discuss these symptoms with their providers. We will monitor changes in symptoms and symptom management over time.