NOT-HL-22-002 NOSI: Notice of Special Interest: Resilience and Vulnerability following Acute Heart, Lung, Blood, and Sleep Insults in People with HIV (R01, Clinical Trial Not Allowed)

Worldwide, over 37 million people are living with HIV. Despite the success of combination antiretroviral therapy (ART) in achieving durable virologic suppression, people with HIV (PWH) are at increased risk for multiple comorbidities. Specifically, studies have shown that PWH are more likely to experience chronic heart, lung, blood, and sleep-related (HLBS) comorbidities, such as cardiomyopathy, chronic obstructive pulmonary disease (COPD), and anemia. Additionally, studies have shown that PWH may experience acute HLBS conditions, including myocardial infarction and acute infectious pneumonia, differently than HIV-uninfected individuals. An area that remains relatively understudied is how PWH experience long-term consequences of an acute HLBS illness/physiologic insult, and whether PWH suffer greater consequences as a result of these acute insults.

The responses to an acute HLBS insult and the mechanisms and determinants of complete recovery vs. persistent residual dysfunction vs. transition to progressive dysfunction/injury define a particular segment of the broader area of inquiry commonly referred to as resilience. This particular subdomain of resilience has been recently thrust into the spotlight by the COVID-19 pandemic. It is increasingly recognized that the acute HLBS insults associated with COVID-19 – myocardial injury, acute respiratory distress syndrome (ARDS), and multisystem microvascular and macrovascular thromboses – are likely associated with long-term HLBS dysfunction in some patients. How these transitions of disease occur and how they may differ in PWH is not at all well understood. More broadly, how PWH may transition between acute HLBS disease and more chronic manifestations differently than people who are HIV-negative is a notable gap in knowledge. This NOSI is intended to begin to address this knowledge gap across the spectrum of HLBS disease research.