Links between Cardiovascular disease, Lung disease, and Obstructive sleep apnea in HIV: Understanding complex patients

People with HIV (PWH) are facing increased morbidity and mortality due to non-infectious heart, lung, blood, and sleep (HLBS) disorders. Many questions remain unanswered regarding HLBS conditions in the current era including the role of emerging risk factors such as COVID-19, newer antiretroviral therapy (ART) medications, non-traditional risk factors such as social determinants of health, and the increasingly complex interactions of HLBS conditions with each other. CFAR Network of Integrated Clinical Systems (CNICS) is an ideal cohort to address questions on the complex interactions of HLBS conditions as it is a large, well-characterized, gender, and racially diverse 8-site cohort with >37,000 PWH. This proposal leverages our prior successful project to incorporate centralized adjudication protocols in CNICS for myocardial infarction (MI), including both type 1 MI due to atheroembolic disease and type 2 MI due to oxygen demand-supply mismatch such as with sepsis; and venous thromboembolism (VTE). We established that MI types in PWH should not be combined, that half of MIs among PWH were type 2 MI, and that affected individuals, risk factors, and mortality differ by MI type. We will build on this work to add new validated outcomes such as obstructive sleep apnea (OSA) and atrial fibrillation (AF). We will compare and validate OSA screening tools using WatchPAT home sleep apnea tests to identify best approaches for implementing widespread brief OSA screening approaches into HIV care. We will also continue to adjudicate HLBS conditions such as MI, VTE, and stroke so that we can tackle important gaps in understanding the complex inter-relationships between individual HLBS conditions. Our multidisciplinary team is uniquely poised to leverage CNICS resources to address important gaps in understanding of HLBS conditions in PWH by pursuing 4 aims. Aim 1 is to compare OSA screening approaches among PWH to improve OSA screening in HIV clinical care. Aim 2 is to determine rates of OSA, AF, MI, VTE, stroke, and chronic obstructive pulmonary disease (COPD) in PWH in the current era and associations with traditional and HIV-specific risk factors. We are particularly interested in the role of emerging risk factors such as newer ART regimens and COVID-19 infection in the setting of an aging population. Aim 3 is to examine the inflammatory burden of OSA and inflammatory risk factors for AF. Aim 4 is to determine the complex interactions of social determinants of health and HLBS diseases on other HLBS conditions as well as to examine the impact of HLBS conditions on COVID-19 outcomes among PWH. New and timely knowledge about the increasing complexity of HLBS conditions among PWH including screening, risk factors, and complex interactions of HLBS conditions with each other and other syndemic conditions will inform clinical decision-making and improve understanding of the mechanisms that increase the frequency of HLBS diseases and risk of poor outcomes in PWH in current clinical care.