Due to mandatory routine HIV testing, the active duty force in the US is a screened population. This unique aspect of the military setting allows understanding of early events and the time course of HIV disease. Because this population is also healthy, racially diverse, and educated, with open access to healthcare and medications, IDCRP is able to conduct investigations without many confounders that plague other cohort studies, such as drug abuse, non-compliance, and poor follow-up. Combined, these assets have resulted in hundreds of published manuscripts that have advanced the fields of HIV science and care. At present, these aspects are being leveraged in many studies, including toward understanding and predicting individual risk of non-AIDS complications.
Identify, treat, and prevent HIV associated neurocognitive disorders in the US military health care system
The principal objective of IDCRP’s human immunodeficiency virus (HIV) research program is to build evidence toward maintaining the health, function, and longevity of HIV+ active duty service members and beneficiaries. This is primarily accomplished through our 28-year U.S. Military HIV Natural History Study, a resource hailed as a “national treasure,” having been leveraged to address contemporary HIV/AIDS-related issues.
As individuals live longer with HIV, thanks to antiretroviral therapy, attention has turned to conditions other than AIDS. HIV-associated neurocognitive disorder (HAND) has emerged as an important concern for the military and the broader population, where it affects up to 50% of HIV+ individuals. In a recent IDCRP study, nearly 20% of HIV+ military members met criteria for HAND. Neurocognitive domains affected by HAND (motor function/dexterity, memory, learning, recall, and executive function) are highly relevant to military duties, and concern over impairment has been a key factor in restricting duty status of HIV+ personnel. This affects not only the individual service member, but is a significant loss to the military of a trained asset; our study may help inform the revision of this policy through an improved understanding of HAND.
In collaboration with the Walter Reed National Military Medical Center Bethesda, the Naval Medical Center San Diego, the National Institute of Neurologic Disorders and Stroke, and five other NIH institutes and centers, IDCRP have undertaken a 5-year study of military HIV+ individuals to better understand the causes and development of HAND, improve diagnosis and screening, and form the basis for studies of treatment and prevention. Partnerships with other DoD and HJF programs, including the U.S. Military HIV Research Program (MHRP) and USU Center for Neuroscience and Regenerative Medicine (CNRM), as well as Veterans Affairs (VA) investigators, are being built and strengthened.
The military HIV+ population, comprised of young, healthy, racially diverse individuals with little illicit drug use and fewer mental health illnesses than other studied populations, offers an exciting opportunity to better understand HAND. IDCRP will extensively characterize the cognitive health of volunteers over time through comprehensive neuropsychiatric testing supplemented by neuroimaging and analysis of cerebrospinal fluid. Initial investigations will include validation of a HAND screening tool developed from our prior study and evaluation of potential biomarkers to improve the objective diagnosis of HAND. With far-reaching goals, IDCRP’s study will benefit both the military and broader population.