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HIV/AIDS-Associated Research Supported by NIAMS
Reviewed November 2013
The success of anti-retroviral therapy (ART) for HIV/AIDS has had a tremendous impact on the longevity of many patients. However, ART and its maintenance of HIV/AIDS as a chronic disease have given rise to several debilitating conditions that affect the musculoskeletal system. The NIAMS's leadership and funding in bone and muscle research provides critical resources for elucidating the mechanisms of these comorbidities of HIV/AIDS. In addition, the NIAMS's support of skin and autoimmune diseases research includes projects in immune system function and structural biology of viruses. Findings from these studies contribute to the understanding of HIV infection and its prevention, as well as the effects of infection-associated inflammation on bone, muscle, and other tissues.
Abnormal weight loss is a common characteristic of patients with HIV/AIDS, which often includes skeletal muscle wasting. The NIAMS supports research on many molecular mechanisms of muscle degeneration that may be related to this condition in HIV/AIDS patients, such as inflammation, metabolic changes, and muscle disuse and damage. The Institute funds numerous studies on treatments and approaches to block muscle degeneration, as well as regeneration of these tissues. NIAMS-supported research on fundamental molecular, cellular, and physiological processes, and development and testing of drug and non-pharmacologic interventions, such as exercise and nutrition, have important implications for the maintenance of muscle strength and physical activity in the HIV/AIDS patient population.
Effects of HIV Infection and Anti-retroviral Therapy on Bones
Osteoporosis and bone fractures are becoming more frequent among HIV/AIDS patients. These conditions may be direct effects of the disease or the treatments, such as ART, a result of an older patient population, or, in some cases, a combination of both. The immune system may also be involved with bone complications in HIV/AIDS, through the repercussions of persistent inflammation from chronic HIV infection. The NIAMS funds a large body of research on bone physiology, osteoporosis, and bone fractures, including the metabolic processes affecting bone quality and bone resorption.
Defense Mechanisms in the Skin
NIAMS-supported research on immune function in skin may provide important insights into the ability of HIV to enter the body through mucosal tissues (such as genital mucosa) and establish infection. Anti-microbial peptides (AMPs) are naturally-occurring molecules in the skin and mucosal tissues that fight many invading pathogens, and some have been shown to inhibit HIV replication. In additional studies funded by the NIAMS, Langerhans cells, which are immune cells specific to skin and particular layers of mucosal tissues, have been shown to be affected by nervous system components, which may have subsequent effects on the immune system's ability to block HIV infection. Such findings and further research may inform the development of HIV vaccines and other HIV prevention strategies.
Patient-reported Outcomes of Routine HIV Care
The NIAMS manages an NIH Roadmap for Medical Research initiative called the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS is developing new ways to measure patient-reported outcomes, such as pain, fatigue, physical functioning, emotional distress, and social role participation, which have a major impact on quality of life across a variety of chronic diseases. In an effort to improve health care and outcomes for HIV-infected patients in clinical settings, a project co-funded by the NIH Office of AIDS Research (OAR) and the NIAMS will create and test measures of HIV/AIDS patient-reported outcomes. This study may provide important information for routine clinical care for patients with HIV/AIDS.
For additional information about HIV/AIDS research supported by the NIAMS, please contact:
Carl C. Baker, MD, PhD