Q: Tell us a little about yourself - where did you do your training? What did you do it in?
A: I have always loved science. My grandfather was a trained chemist and we spent lots of time together talking science. When it was time for university - I went into business (my parents run their own business and I was planning to get involved). I lasted 2 years - then I begged the Chair of Biology to let me transfer. After that everything felt right. I finished my undergrad at Wilfrid Laurier University in biology, and then did my PhD training at the University of Toronto with Dr. Kevin Kain. I chose to work with Dr. Kain for two reasons. His area of expertise was malaria, which I thought was a great disease to study, and he was so excited about what he did that his enthusiasm was contagious. I did a post-doc training with Dr. Tania Watts at the department of Immunology at the University of Toronto, where I got my first taste of HIV research.
Q: Please tell us about your current academic/institutional positions and affiliations as they relate to research in HIV:
A: I am currently a Scientist at the Sandra Rotman Centre for Global Health, and I am an Assistant Scientist at the Toronto General Research Institute at the University Health Network. I am also very involved with IHPREG (the Interdisciplinary HIV Pregnancy Research Group). This is a group of Ontario based multidisciplinary researchers (social, basic, community, clinicians, etc) with an interest in HIV and pregnancy.
Q: Your work focuses on both HIV and Malaria, but HIV seems to be a relatively new area of research for you - how did you come to develop an interest in HIV?
A: It was a bit of a fortuitous evolution. I did my training in the malaria field. But HIV and malaria are diseases that overlap geographically, mostly in sub-Saharan Africa where close to 30 million people are living with HIV and about 200 million people are infected with malaria each year. One of my projects related to HIV and malaria co-infection in pregnancy, which got me interested in HIV. Around the same time I had my first child, which got me even more interested in pregnancy. I was then lucky enough to rekindle an old relationship with Dr. Mona Loutfy, who is the head of the Women and HIV program at Women's College, and was initiating the IHPREG group. The final (and very important) event was that I received a Junior Investigator Development Award from OHTN to study HIV in pregnancy. So all the elements came together to allow me to move into the HIV field, which I am very excited about.
Q: Tell us a bit about the OHTN funded research you're currently pursuing related to angiogenesis and adverse pregnancy outcomes in women living with HIV:
A: Women that are living with HIV tend to have more complications during their pregnancy. This could be related to their infection, but also to the type of antiretroviral drugs they are taking. Combination antiretroviral therapy has been a great thing, enabling women to live longer, fuller lives that include safe childbearing. However, there is some evidence to suggest that HIV-positive women on combination therapy have a higher risk for some adverse pregnancy outcomes, such as having a pre-term delivery and having a low birth weight baby. I am trying to understand how and why this happens. One of the theories we are investigating is that the angiogenic process is altered in these women and that this contributes to their adverse pregnancy outcomes. Angiogenesis is the process of forming blood vessel, and it is a very important process for the development of a healthy placenta. A healthy placenta is needed to provide the baby with all the nutrients and oxygen it needs to develop properly. If the blood vessels are not properly formed, then the placenta will not function optimally, and the development of the baby may suffer.
One of the ways we can check if the angiogenic process is altered is by measuring certain angiogenic factors in the blood. As part of this research project we are following HIV-positive and HIV-negative pregnant women, taking blood sample from them throughout their pregnancy. We will use these blood samples to measure the levels of angiogenic factors and see if there are differences between HIV-positive and HIV-negative women, if there are differences between antiretroviral drug regimens, and if there is a relation between these factors and the pregnancy outcome. We are also studying this process in the lab using placenta cells and mice. With these experiments we can ask very specific mechanistic questions that are not possible to ask in humans, but can help us to better understand what is happening in our HIV-positive pregnant women.
Ultimately, we are hoping to use this research to develop diagnostic tools that can identify women with a high-risk pregnancy as early as possible, so they can be given extra care to ensure that they have the best outcome possible. We are also hoping to identify antiretroviral regimens that are most suitable for use during pregnancy.
Q: Can you talk about any early results you're seeing (in general terms)?
A: We are still in the early phase of recruiting our pregnancy cohort, however I can tell you that even with the small number of HIV-positive women we have recruited so far, we are observing a fairly high number of adverse pregnancy outcomes. This suggests to me that this is a worthwhile pursuit, and that our work is addressing an issue that is relevant to these women.
We do have some early results that suggest that certain antiretroviral drugs have an affect on angiogenic factors and alter the function of placenta cells. We are also developing a mouse pregnancy model to study the effect of antiretroviral drugs on pregnancy outcome, and so far we have been able to replicate the pre-term and low birth weight outcomes we see in HIV-positive women in this model. We are now excited to use this model to figure out how these drugs cause these adverse events, and if there is any way we can prevent them from happening.
Q: You are a Co-Principal Investigator on a CIHR team grant called 'Interdisciplinary HIV Pregnancy Research Group: Care and Research to Optimize HIV-positive Women's Health during Preconception, Pregnancy and Motherhood' - can you tell us a bit about what this program is about?
A: We were very surprised and excited that we received this grant. CIHR issued a call for emerging teams to study maternal health. We (Mona Loutfy, Mark Yudin, and I) put together a letter of intent. CIHR selected 7 teams that were invited to apply, and we were number 7. We knew our chances weren't great but we put the application together. By the end the grant had 3 co-principal investigators and 43 co-investigators. The focus was entirely on HIV-positive women, and it included projects relevant to preconception, pregnancy, and motherhood. CIHR funded 2 projects and ours was number two - we were elated that CIHR chose to fund a maternal health project dedicated to HIV-positive women. The aims of the program are to optimize the care of HIV-positive couples (where one or both partners are HIV-positive) that are contemplating pregnancy; to better understand the impact of antiretroviral therapy on the mother and fetus during pregnancy; and to explore the likelihood of depression and to understand the unique needs of HIV-positive mothers. With this grant we are also developing new collaborations between people whose work focuses on maternal health and HIV. A significant portion of the funds are dedicated to training and mentoring new HIV researchers. Part of this training includes a mentorship program that will help create bidirectional mentorship relationships between researchers, students, and community members. We also have an extensive knowledge translation plan that includes the creation of an IHPREG website - which is launching this week, and an annual conference.
Q: Can you talk about how the community is involved in your research? What is your perspective of the value added by involving community in the development, implementation, and diffusion of research?
A: The community is an integral part of my research and my involvement with IHPREG has greatly facilitated this. Through IHPREG, we have a dedicated Community Advisory Board that meets regularly to discuss IHPREG projects including mine. These discussions help shape my research plan, and focus my work on issues that are relevant to the community. For example, I increased my focus on drug safety during pregnancy because that issue was important to community members. Our findings are still quite preliminary, but we have an extensive plan for sharing our data with the community.
Q: Can you tell us briefly about your other research interests (both related to, and not related to, HIV)?
A: One of my other interests is HIV and malaria co-infection and in trying to understand how HIV changes the way the immune system fights malaria. HIV-positive people are much more like to get infected with malaria, to have higher parasite burdens, and to get more severe malaria disease - and we don't completely understand why this is.
I am also still interested in malaria, and specifically on developing therapies for a severe complication of malaria called cerebral malaria. If you develop cerebral malaria you have a 30% chance of dying even if you are receiving the best anti-malarial drugs available. We have been working on developing therapies that target the immune system, because we believe that an over-activated immune response contributes to the development of this syndrome. One of the potential therapies I have been working on since my PhD is a class of drugs currently used for the treatment of type II diabetes.