Grant: TG:Interv. Trial in Inflam. Chronic Cond. - CIHR HIV/AIDS & STBBI Res. Init. LOI

People living with HIV now live increasingly longer, and current data show that some might hope to have normal life expectancy. However, aging-related diseases such as cardiovascular disease, osteoporosis, or neuro-cognitive disease may happen sooner for these people. It is still unclear what are the exact drivers of this premature aging. One leading theory is that in spite of a suppressed viral load due to the antiretrovirals, the presence of HIV in the body continues to irritate the immune system. Even when complete HIV viruses cannot be detected, viral fragments, such as one called glycoprotein 120 (or gp120), can be detected in the blood of people living with HIV. It has been shown in the laboratory that this fragment can activate immune cells and, ultimately, lead to their death. However, a new antiviral drug called fostemsavir can inactivate gp120 and prevent immune cell death. We propose a study to see if fostemsavir can really revert chronic inflammation in people with HIV. We plan to identify and recruit people with HIV that have detectable gp120 in their blood, and randomize them to receive either fostemsavir or an identical placebo. We will measure cardiovascular disease by imaging their heart's blood vessels using a computed tomography (scanner) at the begginning and end of study to see if the medication helps reduce cardiovascular disease. We will also measure inflammation and HIV reservoirs before and after treatment. We also want to engage a team of community partners to help us finalize the design of this trial. For example, what other outcomes do people living and aging with HIV want to explore? We also want to be proactive to facilitate the recruitment of women living with HIV, a group that has been underrepresented in research. Ultimately, our goal if to grant people aging with HIV the most successful aging possible.