HIV, Aging, and the CTN

Due to the success of modern antiretroviral therapy (ART) and an increase in the average age of new HIV diagnoses, the population of Canadians living with HIV is aging. In fact, over 50% of Canadians living with HIV are now over the age of 50. Aging in itself is a complex and poorly understood process, which is experienced differently among people. As with any chronic condition, the interaction between HIV and aging increases this complexity and presents a unique set of challenges to people aging with HIV, health care providers, researchers, and advocates.

The Canadian AIDS Society in partnership with Realize, formerly the Canadian Working Group on HIV and Rehabilitation (CWGHR), describe the following groups for discussion of HIV and aging:

  1. Canadians who have known they were HIV-positive for many years, and who are now over 50 years of age;
  2. Canadians over 50 who have recently been infected and diagnosed with HIV;
  3. Canadians over 50 receiving a late diagnosis, but who were infected years before; and,
  4. Canadians over 50 who are at risk of HIV.

Throughout the years, the CTN has been involved in research to understand, prevent, and reduce health complications related to HIV. This research has changed accordingly to remain current with the field and reflect evolving research priorities and changing demographics.

The CTN is organized into Core Research Teams, a structure that fosters concentrated discussion and development of novel clinical trials and research initiatives. The Clinical Management Science (CMS) Core conducts the majority of the Network’s research related to HIV and aging. The CMS Core focuses on the needs of people living with HIV in various stages of care and is co-led by Drs. Fiona Smaill and Sharon Walmsley.

HIV and Aging: Core Concepts

Diseases related to aging include cardiovascular disease, kidney impairment, osteoporosis, and neurocognitive disorders. Some studies show that some comorbidities such as osteoporosis and frailty occur earlier in people living with HIV compared to the general population by about 5 to 10 years. Other research shows that some conditions such as cardiovascular disease, and kidney and liver impairment are accentuated. The process behind this is unclear and is not seen in every person living with HIV. Other studies suggest that we see more comorbidities related to behavioural risk (such as smoking and poor diet) along with a greater prevalence of depression.

What is known about aging with HIV is that the immune system remains activated, even when viral suppression is maintained, resulting in a state of chronic inflammation often referred to as “inflammaging”. This persistent, low-level inflammation is thought to occur for a number of reasons including, but not limited to: replication of HIV that remains hidden in viral reservoirs, impairment of and direct damage to the gastrointestinal tract (known as leaky gut or microbial translocation), and co-infection with other viruses. The overall consequence of chronic inflammation is the decline in the function, replication, and health of the body’s immune cells (T-cells). A similar deterioration in T-cells is seen throughout the normal process of aging. For more information about chronic inflammation and immune activation see this short blog post or the Body for a more in-depth overview.

When another disease occurs alongside a primary disease, HIV in this case, the secondary disease is referred to as a comorbidity. Comorbidities may be caused by the primary disease or occur independently. Examples of comorbidities in people living with HIV are cancer; diabetes; cardiovascular, liver, and kidney disease; and co-infections like hepatitis C and syphilis. In the early days of the epidemic, AIDS-defining illnesses, such as Kaposi’s sarcoma, were a result of HIV. Now that people with HIV are living longer, healthier lives, the causality between HIV and some comorbidities is less clear. Understanding and separating out the effect of HIV, ART, and age on these comorbidities is difficult. Behavioural factors­—such as diet and physical activity—and social factors like housing and food security can also contribute to comorbid conditions.

Observing HIV+ Aging: Cohort Studies

Because of gaps in our understanding of aging with HIV, there is much to be learned from simply observing people living with HIV who are receiving regular care over time. Currently, the Canadian HIV and Aging Cohort (CTN 272) is underway as a prospective, observational study. This study has recruited over 1,000 HIV+ and HIV- participants. By following participants for between 5 and 8 years, CTN 272 will compare the rates of cardiovascular events (such as heart attack, stroke, and angina or chest pain) between those living with and without HIV. Secondarily, researchers hope to compare rates of diabetes, kidney failure, and decreased bone health as well as the mechanisms and characteristics of these diseases in both groups.

 

The Canadian Observational Cohort (CANOC) Collaboration (CTN 242) is a national partnership of nine cohorts across Canada. This collaborative cohort follows more than 10,000 people living with HIV who are accessing ART. Almost 50% of HIV+ Canadians who accessed treatment since 2000 are included under the CANOC umbrella. One of CANOC’s research theme’s address the burden of aging-associated co-morbidities. This research theme is comprised of five working groups, some led by CTN researchers:

  • Renal outcomes working group: led by Drs. Mark Hull and Marianne Harris
  • Liver outcomes working group: led by CTN National Co-director Dr. Marina Klein and Dr. Curtis Cooper
  • Cancer working group: led by Dr. Ann Burchell
  • Cardiovascular working group: led by Dr. Marek Smieja
  • Mental health working group: led by Dr. Sean Rourke

Investigating the above comorbidities within the cohort will help inform clinical and research priorities.

Analyses and publications from CANOC have been instrumental in the current understanding of Canadians aging with HIV. A recent collaboration between CANOC and cohorts in the UK, Europe, and the US, looked at the effect of HIV subtype on long-term outcomes. Another analysis looked for differences in clinical outcomes in people living with HIV and HCV with and without a history of injection drug use. CANOC also participated in another large cohort collaboration to understand the rates of, and factors related to, end-stage kidney disease in North American adults living with HIV.

Along with HIV-associated co-morbidities, other research themes in CANOC include quality of HIV care, quality of life, cost-effectiveness of interventions for modern HIV management, and effectiveness and safety of modern ART.

 

Another cohort in which the CTN is involved is the Cellular Aging and HIV Comorbidities in Women and Children (CARMA) Cohort. This cohort is a large, federally funded study that is looking at a wide range of risk factors associated with health problems in HIV+ women as well as children exposed to ART during development. An ongoing sub-study of this cohort, the CARMA-ENDO study (CTN 277) is comparing the prevalence of endocrine, metabolic, and reproductive complications between women living with and without HIV. These complications increase with age and may be more common in HIV-positive people. By collecting markers of accelerated cellular aging—telomere length and alterations in mitochondrial DNA—CTN 277 researchers are looking for possible explanations for this discrepancy.

 

The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS – CTN 262) is a large, community-based prospective cohort study supported by the CTN. The broad aim of this study is to look at the distribution, use, and factors related to women-centered HIV services and how these services affect health outcomes in Canadian women living with HIV. In relation to HIV and aging, the CHIWOS group is researching the relationship between premature ovarian failure and menopause and HIV.

HIV, Aging and Comorbidity Research

 

Cardiovascular Health: From then to now

In the early days of the epidemic, the CTN was involved in optimizing effective ART medications and secondary treatments to address the side effects of these drugs. At that time, cardiovascular health was significantly impacted by ART with increases in cholesterol and triglycerides (a type of fat) in the blood and progression of atherosclerosis (hardening of the arteries). CTN 157 looked at the impact of two medications (L-carnitine and fenofibrate) on lowering blood triglycerides and a sub-study looked at the effect of these two approaches on fasting blood cholesterol, C-peptide (residue in the formation of insulin), and insulin levels. CTN 178 tested the effect of rosiglitazone (Avandia®) in an attempt to reduce atherosclerosis in people taking ART. Although the effects of the study treatment in both CTN 157 and 178 were not found to be statistically significant, both studies showed a promising trend toward improving cardiovascular health. Another study, CTN 175, used nevirapine to lower cholesterol levels in people taking protease inhibitor-containing ART, however, the study was closed early due to low enrolment.

 

Chronic immune activation and inflammation continue to impact cardiovascular health making it an ongoing focus of research. The Niaspan Study (CTNPT 006) is looking at the effect of extended-release niacin (vitamin B3) on immune activation with a secondary goal of assessing changes in cholesterol, triglycerides, and neurocognitive scores. This pilot study has reached its recruitment goals and is now in data follow-up with results expected soon. Although not directly related to cardiovascular health, the CTN’s Vaccines and Immunotherapies (VIT) Core continues to research interventions to reduce viral reservoirs, inflammation, and immune activation.

 

The REPRIEVE trial (A5332, CTN 293 – Randomized Trial to Prevent Vascular Events in HIV) is the first large-scale multinational Phase IV study to test a strategy for heart disease prevention in people living with HIV. The study will enroll 6,500 participants in the US, Canada, and Thailand over the course of six years. The study is seeking to determine whether people living with HIV should be prescribed statins as a preventive measure, even if they don’t qualify for statins under current guidelines.

 

For more information on HIV and cardiovascular disease, see this article from CATIE.

Bone Health

In the early 2000s, the CTN took part in the large, international Strategies for Management of ART (SMART) study (CTN 190). The SMART study included over 300 sites in 33 countries; the CTN was charged with managing the 10 Canadian sites. At the time, available ART drugs were more toxic and caused significant side effects. The primary purpose of the study was to compare the effectiveness of taking ART only when needed (episodic use) versus continual ART use. As we know today, people whose ART use is interrupted or sporadic are more likely to experience adverse clinical outcomes than people who adhere strictly to their regimen. Because of this finding, the study was ended early and participants were encouraged to use ART continually; data from this study has been used in over 30 research publications. Of particular interest to the area of HIV and aging was the finding from a SMART sub-study that continuous ART decreased bone mineral density (BMD) compared to intermittent ART.

BMD loss occurs with increasing age, making osteoporosis (bone fragility) one of the most common diseases related to aging. Osteoporosis and BMD loss is more common and more severe in people living with HIV which may increase BMD loss directly through its immune and inflammatory effects. Some ART drugs can also contribute to an increased rate of BMD loss. Since the SMART study, the CTN has initiated two pilot trials to study bone health and HIV.

 

CTNPT 001, CTN’s first pilot trial, compared bone characteristics between people living with HIV with and without a history of bone fracture. This small study suggests there may be a difference in bone structure, health, and function between these two groups and explored new techniques that could be useful in assessing bone health.

 

CTNPT 021, the BATARI pilot trial, is looking at the effect of a bone anti-resorptive therapy (alendronate with vitamin D) to prevent BMD loss during the first year of initiating HIV treatment. The first year of ART is when the majority of BMD loss occurs and the BATARI pilot trial hopes to aid in the design of a larger clinical trial.

 

The rate of BMD loss may also be affected by the type of ART a person takes. A new study, CTN 299, will look at the effectiveness and safety of switching from tenofovir disoproxil fumarate (TDF), a drug known to increase BMD loss, to tenofovir alafenamide (TAF) among peri-menopausal HIV-positive women. The study will also analyze if the effectiveness of switching is impacted by menopause, a phase of life in which women experience a sharp drop in BMD.

Brain Health

Despite viral suppression, ART adherence, and proper clinical care, brain health may be impacted by HIV. Rates of cognitive impairment and mental health detriments are higher in HIV+ people over the age of 50 than in HIV- people. Brain function may be negatively affected by viral replication, inflammation, the toxic effects of ART, other comorbidities, and by depression, stress, and substance use.

 

Brain Health Now (CTN 273) was implemented with the broad objective of identifying, understanding, and optimizing brain health in people living with HIV. CTN 273 has nearly 1000 participants and is helping researchers refine the way brain health is measured, its determinants, and how it manifests in people over the age of 35. This study is also extremely useful in identifying eligible participants for sub-studies to test new interventions. One such sub-study is CTNPT 026, a pilot study of 80 participants that is assessing the response to an 8-week cognitive training program and the most effective way to measure cognitive changes using magnetic resonance imaging (MRI). For more information about Brain Health Now and associated studies please visit the study website.

A sub-study of the Brain Health Now study is looking at the effect of a computer-based treatment program to improve sleep and cognitive function in people living with HIV who experience insomnia. The digital therapy program used in CTN 290 covers the behavioural, mental, and educational aspects of sleep problems. This study is an example of the lifestyle and behavioural intervention studies supported by the CTN, discussed below.

 

Two small pilot trials, CTNPT 005 and 015, are in data follow-up. CTNPT 005 tested the utility of a computerized neurocognitive assessment tool in comparison to standard neuropsychological testing. For health care workers, this tool requires minimal training and can be used by participants regardless of their language capabilities. CTNPT 015 investigated the usefulness of personalizing ART based on sampling of participants’ cerebrospinal fluid via lumbar puncture. Unfortunately, this study was ended early as the test was found to be ineffective. Discussed above, a secondary objective of the Niaspan Study (CTNPT 006) is to measure the impact of vitamin B3 on neurocognitive scores.

 

CNTPT 029 is testing the feasibility and acceptability of cognitive remediation group therapy in older adults (≥40 years of age) living with HIV who have been diagnosed with HIV-associated neurocognitive disorder. The therapy will include tablet-based cognitive training and mindfulness-based stress reduction sessions.

Impacts on cognitive ability aside, mental health in relation to living with HIV is complex. Stress levels, coping, physical health, and social factors all play important roles. Accordingly, CTN researchers and knowledge users are now turning to interventions and measures relating to lifestyle factors and behaviours.

Health and Lifestyle

 

Healthy behaviours like increasing physical activity, eating well, and substance-use moderation are recommended and encouraged for people of all ages. Because of an increased susceptibility to age-related conditions such as cardiovascular and metabolic disorders, people living with HIV can benefit significantly from lifestyle modification. CTN 288, LHIVE Healthy, is evaluating the effectiveness of a web-based intervention to support people living with HIV to adopt healthy behaviours. Using personalized virtual nurses, this study will support participants in all ages in one of three behaviour modifications: eating better, exercising more, or stopping smoking.

 

Healthy behaviours like increasing physical activity, eating well, and substance-use moderation are recommended and encouraged for people of all ages. Because of an increased susceptibility to age-related conditions such as cardiovascular and metabolic disorders, people living with HIV can benefit significantly from lifestyle modification. CTN 288, LHIVE Healthy, is evaluating the effectiveness of a web-based intervention to support people living with HIV to adopt healthy behaviours. Using personalized virtual nurses, this study will support participants in all ages in one of three behaviour modifications: eating better, exercising more, or stopping smoking.

 

Smoking is a risk factor for cardiovascular disease and is very common among people living with HIV. The CTN supported a pilot trial (CTNPT 008) that looked at the effectiveness of a counselling program in combination with a nicotine patch to improve quitting rates. By looking at depression as a cause of smoking habits, this study highlighted the importance of addressing mental health as a barrier to smoking cessation and improving overall health. The larger follow-up study, funded by CIHR, unfortunately ended early due to issues with recruitment.

 

Adherence to an appropriate treatment regimen is the most important and impactful behaviour that someone living with HIV can do to achieve an undetectable viral load and maintain their health. With this in mind, the I-Score Study (CTN 283) is creating a patient-focused questionnaire to understand, from the point of view of a person living with HIV, the factors that affect their treatment adherence. A tailored approach, based on what individuals see as obstacles to following their treatment schedule and what they struggle with, can help to better orient patient-provider discussions of adherence and the modification of prescribed treatments to optimize them based on individual needs.

HIV and Aging Research in Canada

 

Outside the CTN, Canadian researchers have contributed significantly to HIV and aging research and our understanding of HIV and the aging process. Researchers at Dalhousie University have collaborated several times with Italian researcher Dr. Giovanni Guaraldi, who is also co-principal investigator for CTN 299. This work has focused on defining and developing a frailty index specific to HIV. At the University of Toronto, Dr. Kelly O’Brien is using data from the HIV, Health, and Rehabilitation Survey (HHRS) to profile disabilities and comorbidities in HIV+ Canadians and their use of rehabilitation services. Dr. O’Brien is also implementing a CIHR-funded community-based exercise intervention study in HIV+ adults in partnership with the YMCA Toronto. Also at U of T, PhD candidate Hannah Kia is collecting interview data to understand the health care experiences of older gay men, half of which are living with HIV.

McMaster University is also involved in HIV and aging research. Dr. Patty Solomon is conducting a longitudinal of health in people aging with HIV. PhD candidate Charles Furlotte has written on approaches to successful aging in older adults and his thesis project is focusing on aging with HIV from the perspective of gay men in Toronto. At the Centre for Addiction and Mental Health in Toronto, Dr. Sergio Rueda has published extensively on HIV and quality of life, among other topics, and is currently building a framework to understand successful aging with HIV. The Ontario HIV Treatment Network (OHTN) has a significant body of work relating to HIV and dementia and other comorbidities. Finally, the Public Health Agency of Canada continues to compare the needs of people living with and without HIV in both home and long-term care settings.

The above examples are just a small selection of the research that is ongoing in Canada. There is a diverse group of scientists, knowledge users, and community members that are expanding our knowledge of HIV and aging, from lab-based studies to community and social program implementation.

TABLE OF CTN STUDIES ON HIV AND AGING:

CTN StudyShort NamePrincipal Investigator(s)Long NameStudy Description
CTN 272Canadian HIV and Aging cohortDr. Cécile Tremblay
Dr Madeleine Durand
The Canadian HIV and Aging Cohort – Determinants of increased risk of cardiovascular diseases in individuals living with HIVThis study will investigate accelerated aging in people living with HIV, looking in particular at cardiovascular disease (CVD). Researchers will also develop tools for analyzing chemical signals in the blood that may help further understanding of many aging related health issues like heart disease, diabetes, kidney disease, memory loss, and brittle bones. The researchers will look for factors that impact on longevity including: the age of the person when infection occurred, the CD4 cell count, the time spent with CD4 count of greater than 500 cells/mm3 and other variables. The study is a large controlled cohort looking to enroll 2000 participants (half with HIV and half without). Participants will be followed for five years and will be invited to participate in the main cohort as well as any or all of the four pre-planned sub-studies. The sub studies are looking at plaque build up in the arteries, abnormalities in blood glucose levels as an indicator of disease, immune system reaction to CVD, and genetic testing.
CTN 242Canadian observational cohort (CANOC) collaboration) Dr. Robert HoggThis is an observational study and is designed to examine and link HIV/AIDS information drawn from databases across CanadaThis collaboration has three primary objectives:
1. To develop a nationally and internationally recognized and policy- relevant program of research in HIV therapeutics and population and public health and to build upon the expertise of Canadian researchers
2. To establish training and research opportunities for graduate students, post-doctoral fellows and clinicians across the country interested in HIV/AIDS cohort research
3. To improve research dissemination to physicians and persons living with HIV and to improve the knowledge translation of research on HIV/AIDS therapeutics into provincial, national and international HIV/AIDS treatment guidelines
CTN 277Endocrinopathy & cellular ging in women and girlsMelanie MurrayEndocrinopathy & cellular aging in women and girls enrolled in the CARMA cohortThe purpose of this observational study is to assess the prevalence of various endocrine, metabolic and reproductive abnormalities in HIV-positive and HIV-negative women and female youth in the CARMA-2 (also referred to by the team as ‘CORE’) cohort, and to determine possible links between abnormalities and accelerated cellular aging in women/girls (associated with markers of aging such as shorter LTL [telomere length] and/or mtDNA alterations).
CTN 262Canadian HIV women’s sexual and reproductive health cohort study (CHIWOS)Dr. Mona LoutfyCanadian HIV women’s sexual and reproductive health cohort study, a Canadian observational cohort (CANOC) affiliated studyThis prospective cohort study operates within community-based research, GIPA (greater involvement of people with HIV/AIDS), and MIWA (meaningful involvement of women living with HIV/AIDS) approaches by prioritizing the leadership and experiences of women living with HIV. The aim of the study is to assess the proportion, distribution and patterns of use and uptake of women-centred HIV/AIDS services, and factors associated with service uptake among HIV-positive women living in Canada. This study will also estimate the effect of women-centred HIV/AIDS services uptake on the sexual, reproductive, mental and women’s health outcomes of women living with HIV in Canada.
CTNPT 006The Niaspan® studyDr. Bertrand LebouchéRole of extended-released niacin on immune activation in HIV-infected patients treated with antiretroviral therapy: a proof-of-concept studyThis pilot study will evaluate the effect of a drug called Niaspan®, an extended-release form of niacin (ER niacin), in individuals living with HIV who are on antiretroviral therapy (ART). Researchers will examine the ability of an oral form of ER niacin to reduce immune activation and increase CD4 cells in persons with sub-optimal immune responses despite sustained virologic suppression from ART.
CTN 293REPRIEVE trialDr. Steven K. GrinspoonRandomized Trial to Prevent Vascular Events in HIVREPRIEVE is the first large-scale randomized clinical research trial to test a strategy for heart disease prevention among people living with HIV. Specifically, REPRIEVE will test whether a daily dose of a statin (pitavastatin) reduces the risk of heart disease among people living with HIV.
CTN 190Strategies for management of ART (SMART)Drs. Walter Schlech and David HaaseStrategies for management of ART (SMART)The purpose of this study was to compare the long-term clinical consequences of two strategies of ART: The drug conservation (DC) strategy, aiming at conserving drugs through episodic use of ART for the minimum time to maintain CD4 cell count of at least 250 cells/mm3, versus the viral suppression (VS) strategy, aiming at suppressing viral load as much as possible, immediately following randomization and throughout follow-up, irrespective of CD4 cell count.
CTN 242CANOC – The Canadian Observational CohortDr. Robert HoggAn observational study and is designed to examine and link HIV/AIDS information drawn from databases across CanadaThis large, national cohort study is designed to link HIV databases across Canada and allow researchers to gather observational data for substudies, some of which focus on the viral reservoir and biomarkers. See here for a full study description.
CTNPT 001Fracture case-control study in HIVDr. Darrell TanA case-control study of novel bone imaging techniques and plasma markers in HIV-infected persons with or without fragility fracturesThis pilot study will compare bone architecture parameters (structure and strength) in adults living with HIV and compare new tools for measuring bone health to current methods. The study researchers are recruiting adults living with HIV who have had a fracture after their diagnosis and HIV positive adults who have never had a fracture. The two groups will be similarly matched according to age, sex, smoking status, and race. This study is intended to inform the design of a future intervention trial aimed at reversing the accelerated loss in bone strength seen during the first year of antiretroviral therapy.
CTNPT 021The (BATARI) Pilot TrialDr. Darrell TanBone Antiresorptive Therapy with AntiRetroviral Initiation (BATARI) Pilot TrialHIV medication controls HIV infection and ultimately saves lives. However, HIV medications can also have side effects including moderate weakening of the bones, especially during the first year of treatment. Over time, this can lead to osteoporosis (a disease in which the bones are weak) and an increased risk of fracture (broken bones). For these reasons, the research team is studying whether bone-building medications might benefit people who are starting HIV treatment. This study is a smaller, or ‘pilot’ study that will help the research team plan and design a larger study.
CTN 273Brain Health Now!Drs. Marie-Josée Brouillette and Leslie FellowsUnderstanding and Optimizing Brain Health in HIV NowStudy investigators aim to understand the biological, psychological, and social factors that affect brain health, the impact of cognitive symptoms on function and quality of life, and their evolution over time. Researchers are also focused on developing tools that can be applied in the clinic setting. Measurement of cognition remains a major stumbling block to effective brain health management. To address this unmet need, the researchers have developed a brief computerized test (B-CAM, for Brief Cognitive Ability Measure) that applies cutting-edge statistical methods to assess cognition over time. Once optimized as a result of the study, this web-based open-access (meaning, free!) tool could be used in the clinic setting to measure cognitive abilities in a few minutes. Pilot interventional sub-studies aimed at improving brain health are also planned, for which participants in the larger cohort study will be invited to participate.
CTNPT 026 Neuroimaging as a biomarker for cognitive training in HANDDr. Lesley FellowsBrain imaging to understand HIV-associated neurocognitive disorder and predict response to cognitive trainingThis study aims to answer three questions. Which magnetic resonance imaging (MRI) techniques:
are most effective at showing the difference between HIV+ people with high and low cognitive ability?
are most effective at predicting the response to an 8-week computerized cognitive training program? (MRI scan at the start of the program)
are most effective at showing the difference between those with a positive response to this program and those whose cognitive ability does not improve? (MRI scan at the end of the program)
CTN 290HIV and SleepDr. Lesley Fellows & Dr. Marie-Josée BrouilletteEfficacy potential of an internet-based sleep program to improve sleep quality in people with HIVThe goal of this study is to see if a computer-based treatment program can improve sleep and cognitive (mental) function in people living with HIV (PLHIV) who are experiencing insomnia (difficulty sleeping). This study is expected to produce important data that could lead to effective treatments and strategies for improving sleep and brain function in PLHIV that are experiencing cognitive decline. Results from this study could also lead to a larger-scale trial.
CTNPT 005Measuring cognition in HIVDrs. Marie-Josée Brouillette and Marina KleinMeasuring cognitive decline in patients at high risk for developing HIV-related neurocognitive dysfunctionThis CTN pilot study will assess changes in neurocognitive functioning — the ability to think and reason — over one year in individuals at risk for neurocognitive decline despite virologic suppression of HIV. This is a non-interventional study; no experimental treatment will be administered. Results of this pilot study may generate important data for future clinical trials aimed at maintaining or improving cognitive functioning in at-risk individuals.
CTNPT 015COMO cognition study with HIV+ patientsDr. Marie-Josée BrouillettePilot project to implement a step-wise investigation that includes Cerebrospinal Fluid analysis as a standard of care for HIV+ individuals with cognitive symptomsThe purpose of this study is to describe the clinical characteristics of HIV+ individuals assessed for cognitive difficulties, assess changes in neurocognitive functioning over six months following the implementation of a change in ARV’s and evaluate the capacity of a brief tool to measure cognition in tracking cognitive change over time.
CTNPT 029Psychosocial intervention for older HIV+ adults with HANDMr. Andrew EatonDevelopment of a psychosocial intervention trial with the goal to improve older adults’ ability to cope with HIV-Associated Neurocognitive Disorder (HAND)CNTPT 029 will test the feasibility and acceptability of cognitive remediation group therapy in older adults living with HIV who have been diagnosed with HIV-associated neurocognitive disorder (HAND). The cognitive remediation therapy will include tablet-based cognitive training and mindfulness-based stress reduction sessions.
CTNPT 288LHIVE HealthyJosé Côte RN, PhD
Dr. Cécile Tremblay
Evaluation of web-based interventions to support people living with HIV in the adoption of health behavioursThe main objective of this study is to evaluate the effectiveness of web-based interventions in supporting people living with HIV (PLHIV) to adopt healthy behaviours (stopping smoking, exercising more, and eating better).
CTNPT 008HIV quit smoking pilot studyDr. Louise BalfourThe rates of cardiovascular disease (CVD) are high among people living with HIV. Two of the factors thought to contribute to this inflated risk are increased smoking rates and the prevalence of depression in people living with HIV. Smoking is a direct risk factor for CVD and depression makes quitting smoking and remaining smoke-free more difficult. Therefore, the increase in depression and smoking rates may interact to increase the rates of CVD in people living with HIV. CTNPT 008 looked at the effectiveness of a counselling programme, in combination with nicotine replacement therapy (nicotine patch) to improve quitting rates. The counselling sessions focused on quitting smoking and addressing depression.
CTNPT 283the I-Score StudyDr. Bertrand Lebouché The development and validation of a patient-reported measure of antiretroviral therapy’s interference with life: a clinical patient-management tool for healthcare providersThe aim of this study is to create a patient questionnaire that will help to determine, from the point of view of people living with HIV, how easy or hard it is to stay on antiretroviral treatment (ART). The purpose of the questionnaire will be to signal the reasons patients feel make taking ART difficult or inconvenient. This questionnaire will be filled out electronically, theory-based, and easy to use. Importantly, it aims to help doctors discuss and address treatment problems with their patients, and will help both doctors and researchers better understand the impacts of ART on patients.
CTNPT 299BonE health in ageING Women (BEING-W)Dr. Sharon Walmsley & Dr. Giovanni GuaraldiBonE health in ageING Women: improvement or prevention of changes in bone mineral density by switching antiretroviral agents: BEING-WCTN 299 will assess the impact of switching combination antiretroviral therapy (cART) on the bone health of women living with HIV between the ages of 45 and 55 in Canada and Italy. Secondarily, this study will determine whether the effectiveness of switching is dependent on when the switch occurs in relation to menopause. Tenofovir (TDF) is a common component in cART regimens but also increases the rate of bone mineral density (BMD) loss and decline in kidney function. This trial, an investigator-initiated study supported by a grant from Gilead Sciences, will study whether switching from TDF to tenofovir alafenamide (TAF) can help prevent or reverse BMD loss in aging women.

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