Antiretroviral drugs successfully suppress the HIV virus and reduce mortality, but many people living with HIV and AIDS cannot benefit fully from the medication due to adverse side effects. These side effects make it difficult for people to take the drugs consistently, or at all. Many side effects do not become apparent until after people have taken antiretroviral drugs for a prolonged period. Dr. Katherine Heath is establishing a monitoring system to track adverse reactions to antiretroviral drugs, identify and describe newly emerging side effects, and assess the impact of these side effects on antiretroviral use in BC. Dr. Heath-based at the BC Centre for Excellence in HIV/AIDS, which houses the only North-American population-based database of information on people using antiretroviral drugs-hopes her research will enable early detection of trends or new side effects, lead to early intervention and ultimately improve the health of people living with HIV and AIDS.
Research Location: Providence Health Care
Cardiac Myocyte Apoptotic and Anti-Apoptotic Signalling Pathways Following Coxsackievirus B3 Infection
Mitra Esfandiarei has a specific goal: making a significant contribution to treatment of myocarditis (inflammation of the heart muscle) induced by a type of enterovirus (virus that comes into the body through the gastrointestinal tract). One such virus, coxsackievirus B3 (CVB3), causes severe cardiac and pancreatic diseases by directly injuring and killing heart muscle cells. In many cases, CVB3-infected myocarditis leads to cardiomyopathy (destruction of the heart muscle), for which the only available treatment is heart transplantation. Esfandiarei is studying how heart muscle cells can survive in the face of infection by CVB3. She hopes the research will enable novel treatment for viral-induced myocarditis and other cardiac conditions.
Host Cell Signalling Following Coxsackievirus B3 Infection: Elucidation of Anti-Apoptotic Survival Mechanisms
Robert Yanagawa’s overall goal as a researcher is to increase our understanding of cardiovascular diseases. With that in mind Yanagawa is investigating Coxsackievirus B3, the primary cause of viral myocarditis (inflammation of the heart muscle), a condition that may result in chronic irregular heart beats, heart failure and sudden death. Organ transplantation is the only definitive treatment for heart failure caused by this virus. Yanagawa is examining the ability of host cells within infected cardiac muscle to activate protective signalling mechanisms. When stimulated, these mechanisms may maintain heart muscle viability, slow replication of the virus and preserve heart function. Yanagawa hopes that establishing new insights about protective mechanisms will ultimately lead to more effective treatments for viral myocarditis.
Issues in the diagnosis and treatment of viral co-infection by the human immunodeficiency virus (HIV) and Hepatitis C (HCV)
While an estimated 30 per cent of British Columbians living with HIV are also infected with Hepatitis C, which is becoming a leading cause of death among HIV-positive people, the issue of co-infection has received relatively little attention. Paula Braitstein hopes to change that by focusing her research on how to most effectively treat people who are co-infected with the diseases. By analysing data from the Vancouver Injection Drug Users Study and Drug Treatment Program of the BC Centre for Excellence in HIV/AIDS, she hopes to answer outstanding questions, such as whether patients fare better when treated for Hepatitis C before beginning HIV treatment. Braitstein believes that finding these answers will have a profound and timely impact on treatment of co-infected individuals. This project builds on a significant body of HIV work that Braitstein has already accumulated. Her goal is to make a substantial contribution to the health of Canadians through a research career in epidemiology.
Barriers to Reproductive Health Care among Marginalized Women in Vancouver, British Columbia
Amy Weber is dedicated to pursuing a career at the forefront of infectious disease research. She’s convinced that rigorous research can create medical and social options to contain the HIV epidemic, alleviate suffering and save lives. While Weber has researched a range of populations at risk, her current work focuses on marginalized women who are increasingly vulnerable to infectious disease and poor health. Weber’s study aims to identify the barriers that marginalized women in Vancouver face in accessing health care. She’s particularly interested in researching the barriers to reproductive health care, such as services related to birth control, pre-natal care, abortion and anti-retroviral therapy for HIV-positive women. Weber believes that providing a better understanding of these barriers will help influence policy to increase access to health services and improve the health of vulnerable women.
Heroin and Methadone Maintenance Treatment: Accessibility, Barriers and Quality of Life issues for Women in the Downtown Eastside, Vancouver, British Columbia
Magdalena Recsky developed her passion for epidemiology while working summers as a research assistant at the BC Centre for Excellence in HIV/AIDS. She put that passion into practice through her Masters research, which explored issues surrounding methadone dosing, satisfaction with methadone doses and associated HIV-risk behaviours. Using existing data, she investigated the barriers women face in accessing methadone maintenance programs, which led to a broader study into methadone dosing. Results from the studies and a literature review demonstrate that high patient satisfaction with methadone treatment can potentially decrease certain HIV-risk behaviours. The results also highlight the importance of physician-patient relationships in the treatment of heroin addiction and the importance of individualizing methadone treatment. Although certain methadone doses are pharmacologically required to curb heroin withdrawal, the research shows that once that dose is reached, patient satisfaction with treatment may be more important in positively influencing methadone treatment outcomes. Ultimately, she hopes this research will contribute to improvements in methadone treatment programs that more effectively address the needs of specific population groups, such as those involved in high HIV-risk behaviours.
Investigations into Risk Factors and Determinants of HIV and Hepatitis C Incidence and Prevalence among High Risk Youth
Researchers have conducted extensive studies of injection drug use in Vancouver, but few have focused specifically on high-risk youth. Enter Cari Miller. Her Masters research — a sub-study of the Vancouver Injection Drug Users Study (VIDUS) — examined prevalence and incidence of HIV and hepatitis C among more than 200 injection drug users aged 13 to 24. Cari has first-hand experience to draw from. She put in 24-hour shifts as a part-time youth worker with the Vancouver Native Health Underage Safe House. Working with youth — most of whom were drug dependent, female and Aboriginal — has fuelled her passion for research and the urgency for new health policies to support them. Results from the research show high prevalence and exceedingly high incidence rates for HIV and hepatitis C among young injection drug users. Her findings indicate that those at highest risk are female and Aboriginal youth engaged in both drug and sexual related risk, and half of young injectors acquire hepatitis C infection during their first two years of injection drug use. Cari hopes that developing a better understanding of the risk behaviours among these young people will lead to more effective prevention and intervention programs. Ultimately, she would like to see more treatment opportunities for high-risk youth.
Molecular and genetic mechanisms of obstructive lung disease
Asthma and chronic obstructive pulmonary disease (COPD), also known as emphysema, are major causes of disease and death worldwide. The prevalence of asthma is increasing, and in some Canadian communities, up to 20 per cent of children are affected. Globally, emphysema ranks twelfth as a cause of lost quantity and quality of life, and is projected to rank fifth by the year 2020 as smoking and air pollution increase around the world. Significant gaps exist in our understanding of these disorders, and while limited therapies are available, none is universally effective or without side effects. I am examining genetic susceptibility for asthma and COPD. Many people smoke and are exposed to allergens, but only a small percentage develop asthma or COPD. For example, cigarette smoking is the major risk factor for COPD, but only 10-20 per cent of smokers develop the disease. Similarly allergy is common, but only some individuals develop asthma. The evidence suggests that susceptibility runs in families, but few genetic risk factors have been identified. My research team is using a registry of lung tissue from patients who have had lung surgery, as well as DNA from large groups of individuals who have these conditions, to identify the genes that account for this susceptibility. We want to discover the molecular mechanisms that cause asthma and COPD, and to predict if an individual’s genetic makeup puts them at increased risk for these disorders. Ultimately, this research should increase understanding of these disorders and contribute to the development of new diagnostic tests, preventative strategies and therapies.
Investigation of the apolipoprotein C-II activation site of human lipoprotein lipase
The enzymes hepatic lipase (HL) and lipoprotein lipase (LPL) play a key role in the metabolism of cholesterol and fat circulating in the blood stream. However, their specific role and capacity to offer protection from heart disease are unclear. My research will identify the parts of each enzyme responsible for performing different functions. This knowledge will more clearly define how these enzymes influence the metabolism of cholesterol and fat and the development of cardiovascular disease. I am combining parts of HL and LPL to create new enzymes that will highlight the differences between the original enzymes’ functions. For example, a fundamental property of enzymes is how they are activated. We know a particular protein that does not activate HL does activate LPL. I will put the portions of LPL we think are responsible for activation into HL to test whether HL is activated and confirm that this part of LPL causes activation. When we know how these enzymes work to regulate and control the level of cholesterol and fat, we will understand their relationship with cardiovascular disease, and should be able to develop enzyme inhibitors or activators to improve cardiovascular health.
Epidemiological and population-based investigations of persons infected with HIV
I am a demographer who is currently involved in observational research into the impact of antiretroviral therapy on quality of life and life expectancy of persons with HIV disease in British Columbia. I am also interested in issues regarding access to antiretroviral therapy in developing nations. My most significant contributions to HIV research include: Studies monitoring seroincidence and determinants of HIV infection and risk behaviour among gay and bisexual men In a natural history study of HIV-positive gay and bisexual men, we demonstrated that lower socioeconomic status decreases the length of survival. Low income was significantly associated with shorter survival from HIV infection to death, even after adjustment for CD4 count (which measures immune suppression in persons with HIV), age at infection, year of infection and use of HIV therapies and prophylaxis. Studies measuring the impact of HIV infection on population health My primary goal in the area of population health research has been examining the impact of HIV on patterns of mortality, migration and hospitalization in Canada. One study I conducted showed that although there are barriers to widespread HIV treatment, limited used of antiretroviral therapy could have an immediate impact on South Africa’s AIDS epidemic. A second study demonstrated that the cost of making combination antiretroviral therapy available worldwide would be exceedingly high, especially in countries with limited financial resources. Studies evaluating the impact of antiretroviral therapy on the health and well-being of persons with HIV disease One of my studies demonstrated a significant reduction in mortality and AIDS-free survival for HIV infected individuals who initiated therapy with regimens including stavudine or lamivudine compared to those who initiated therapy with regimes limited to zidovudine, didanosine and zalcitabine.