NHLBI’s MACS/WIHS study targets chronic health conditions in people living with HIV

In the 1980s, infection with HIV, the virus that causes AIDS, was often viewed as a death sentence. With no treatments available and little understanding of the virus or the disease, hundreds of thousands of people in the United States ultimately lost their lives and millions more died worldwide.

Much has changed in the past four decades. Thanks to the availability of powerful antiretroviral drugs, new infections have decreased significantly, the virus is held at low levels in the body, and the HIV death rate has plummeted. People living with HIV are now more likely to die of a chronic illness, such as cardiovascular disease, than from AIDS. Meanwhile, researchers continue to make inroads in finding an effective vaccine or even a cure.

Now, this year, another milestone: the nation’s largest and longest running study of HIV survivors is marking its 40th anniversary.

The Multicenter AIDS Cohort Study (MACS) launched in 1984 to help shed light on how AIDS was affecting gay and bisexual men living with or at risk for HIV. Over the years it enrolled some 7,300 men and eventually merged with the Women’s Interagency HIV Study (WIHS). That study has focused on the health impact of HIV on nearly 5,000 women living with or at risk for the virus.

Since then, the combined research effort – the so-called MACS/WIHS Combined Cohort Study – has been pursuing an ambitious goal: to understand and reduce the impact of chronic health conditions, including heart, lung, blood, and sleep disorders, that affect people living with HIV. That’s an estimated 1.1 million people ages 13 and older in the United States and the nearly 37 million people worldwide.

The study – coordinated by the NHLBI and conducted in collaboration with the NIH Office of AIDS Research and several co-funding institutes – not only has produced a host of findings; it also has provided a way to take stock of what its research has meant for real people.

“It’s amazing today to see that people with HIV are surviving into old age,” said Beth Pathak, Ph.D., NHLBI’s program director of the MACS/WIHS study and an epidemiologist. “On the other hand, HIV/AIDS is still a big public health problem around the world. We still have a lot more to learn.”

Pathak says that the program will honor the legacy of the participants with a specially designed panel on the National AIDS Memorial quilt. That panel will be unveiled on December 5 during a special ceremony in Washington, D.C.

David C. Goff, M.D., Ph.D., director of the NHLBI’s Division of Cardiovascular Sciences, said the MACS/WIHS study is often called the “jewel in the crown” of NIH HIV/AIDS research for good reason. To date, MACS/WIHS investigators have published over 2,000 articles on HIV-related topics. Those studies show that people living with HIV tend to carry a higher disease burden. Nearly half of HIV survivors over 50 develop one or more chronic conditions not directly associated with HIV itself – cardiovascular disease, lung diseases such as pulmonary hypertension and COPD, anemias and other blood-related disorders, sleep disorders, cognitive dysfunction, osteoporosis, and certain cancers. While common in older people generally, these conditions tend to show up at higher rates in younger people with HIV.

Some of the more important findings to emerge from the MACS/WIHS research program have direct relevance to NHLBI’s research focus areas:

• Men and women living with HIV have a higher burden of heart disease than those without HIV.
• Men and women living with HIV are more likely to have abnormal lung function than those without HIV.
• Women living with HIV have a higher comorbidity burden (health problems) than men with HIV.
• Untreated HIV lowers levels of ‘good’ cholesterol (high-density lipoprotein (HDL) cholesterol).
• High-risk coronary artery plaque is more common in men with HIV than their HIV-negative counterparts.
• At the DNA level, men living with HIV appear to age faster than men without.
• Men with HIV are more likely to have sleep-disordered breathing.
• People living with HIV have lower antibodies and greater inflammation from the COVID-19 vaccines.
• Smoking is strongly linked to atherosclerosis in men with HIV.

NHLBI’s Goff said findings like these are critical to research that could lead to better treatments for those with the disease. It’s why it is so important, he said, to “keep the study going.”

After all, he noted, “it’s one of the world’s most important sources of rigorous scientific knowledge about the evolving impact of HIV infection and its comorbidities on human health.”