The Mater-Bronx Rapid HIV Testing Project. M-BRiHT involves collaborations between UCD, MMUH and the Jacobi Medical Centre in the Bronx, New York. M-BRiHT explores the acceptability and feasibility of implementing unselected rapid HIV screening with a novel computer-based video counselling programme in hospital Emergency Departments over 3 sites – the MMUH in Dublin, Manchester in the UK and Catania in Italy. M-BRiHT demonstrates the feasibility of implementing large-scale, population-based HIV screening within a European ED. 14,000 participants have been recruited to date with overall high population prevalence (2.08/1000 new infections) and high completion rates (89.6%). The computer-based video counselling and risk assessment interface has been produced in 2 dialects of English as well as Italian

The HMRG coordinates the ‘UPBEAT’ study which examines the pathogenesis of osteoporosis and low bone mineral density in people with HIV. UPBEAT, one of the largest studies of its kind internationally, has followed a cohort of people both with and without HIV for the past five years and has come up with several important findings.

• Since 2011, the HIV UPBEAT study has enrolled over 500 individuals, approximately half of whom are living with HIV, over a period of 5 years to compare their BMD and other tests related to bone health. Once a year, participants complete a questionnaire about their health; they receive a DXA scan and laboratory testing.
• By comparing the results we have so far, we found that people with HIV have lower bone mineral density and higher bone turnover, a test that shows how much the tissue in bone leaves the skeleton. However, a more recent analysis has shown that bone density in those with HIV changes at the same rate as those without HIV, which is reassuring that once people with HIV are on stable antiretroviral treatment that they do not seem to lose bone at any faster rate than those without HIV.
• As we continue this important study, we hope to learn more about the connection between HIV and bone health. This information will help healthcare providers better understand how to prevent, test and treat low BMD in people living with HIV so that we can maintain health over the long term.
• The HMRG is also investigating novel treatments to prevent bone loss in people with HIV. The APART Study is an international, multisite study funded by the Health Research Board that aims to explore whether a commonly used cheap treatment to prevent bone loss can stop bone loss with initiation of antiretroviral therapy in people with HIV. This study hopes to report findings in 2018.

1. People living with HIV have immune activation that contributes to the pathogenesis of cardiovascular disease.

Work completed by HMRG has shown that people with HIV have an activated immune system that is not corrected with antiretroviral therapy and that this immune activation is characterised by abnormalities linked to increased risk of cardiovascular disease.

2. Cells of people living with HIV have signals which suggest abnormal cholesterol metabolism.

Cells called monocyte / macrophages, important in the pathogenesis of cardiovascular disease, contribute to atherosclerosis by retaining cholesterol which then becomes embedded in the walls of blood vessels. Work led by HMRG involving research sites in Dublin, London and Amsterdam has shown that in people with HIV, monocytes have an abnormal gene signature that suggests their cells have too much cholesterol and these abnormalities are not corrected with antiretroviral treatment. These findings have identified specific targets that may be used in the treatment of these abnormalities in people with HIV.

3.  Some antiretroviral treatments may also alter the risk of cardiovascular disease.

Ground-breaking research conducted by HMRG scientists in collaboration with scientists from the Royal College of Surgeons in Ireland have identified an association between a commonly used antiretroviral drug and activity of platelets, which are important in how the blood clots. Abnormalities in platelet function may increase an individual's risk of heart disease and these findings may explain observations from large international studies linking use of this drug with increased cardiovascular disease. 

Through the UCD-ID Cohort Project, the HIV Immunology Study supported by a number of industry partners aims to explore additional tests that better reflect and predict immune responses to antiretroviral therapy. This study, in collaboration with Rush University Medical Centre in Chicago, has recruited over 200 subjects. We also conducted a cross-sectional study that provides important and new insights into the potential role of CD4+ and CD8+ T-cell subpopulations in immunological responses in HIV.