PROJECT SUMMARY
Current evidence suggests that sub-Saharan Africa is facing a double burden of disease, with HIV and cardi-
ometabolic disease seemingly on a collision course. This is compounded by the growing burden of cardiometa-
bolic disease attributable to HIV, which will further impact already struggling public health resources in the region.
The relative lack of epidemiological and mechanistic studies on the intersection between HIV and cardiometa-
bolic disease in sub-Saharan African populations therefore represents a major knowledge gap. Several factors,
including mitochondrial dysfunction, are implicated in the pathogenesis of HIV-associated cardiometabolic dis-
ease. Mitochondrial dysfunction has been linked to both HIV and cardiometabolic disease and previous studies
have demonstrated mitochondrial involvement in several cardiometabolic-related pathologies in people living
with HIV (PLWH). Whilst a common underlying mechanism of HIV-associated cardiometabolic disease remains
elusive, mitochondrial dysfunction may uniquely drive the pathogenesis of cardiometabolic disease to a greater
extent in people with compared to without HIV. PLWH in sub-Saharan Africa are particularly susceptible to mi-
tochondrial dysfunction due to a unique convergence of intrinsic and extrinsic risk factors, including exposure to
endemic pathogens and high levels of inflammation. In this study, it is hypothesized that antiretroviral therapy
(ART)-experienced PLWH with cardiometabolic disease in sub-Saharan Africa will show greater mitochondrial
dysfunction compared to PLWH without cardiometabolic disease and controls without HIV. The hypothesis will
be tested in an exploratory, cross-sectional study comprising cohorts in South Africa and Kenya. In Specific Aim
1, mitochondrial respiratory function (measured by state-of-the-art high resolution respirometry and fluorometry
technology) will be compared in participants with and without HIV, and it will be determined whether mitochon-
drial dysfunction is more pronounced in PLWH with cardiometabolic disease. In Specific Aim 2, mRNA expres-
sion of genes linked to mitochondrial function and dynamics will be compared in participants with and without
HIV, and it will be determined whether gene expression is different in PLWH with cardiometabolic disease. Re-
lated pathophysiological processes, including inflammatory, immunological and endocrine, will be measured to
complement the mitochondrial function and gene expression experiments in Aims 1 and 2. This exploratory study
will provide preliminary evidence that heightened mitochondrial dysfunction is present in PLWH with cardiomet-
abolic disease from South Africa and Kenya. These results may benefit public health in the region, including
screening of PLWH at risk of mitochondrial dysfunction, revision of 1st line ART that includes drugs with mito-
chondrial toxicity, and stronger emphasis on cardiometabolic disease in PLWH. New research networks in South
Africa, Kenya and the US will be forged, with a strong capacity development focus.
