HIV as a Chronic Disease

In this podcast, Sri Banerjee, MD, PhD, MPH, MAS, discusses inflammatory biomarkers associated with disease progression of HIV, hepatitis B, and hepatitis C, including his team’s investigation of identifying common pathways among infectious and chronic diseases.

Additional Resource:

• Banerjee S, Ofor PO, Patel R, Panas R. Inflammatory markers associated with disease progression of HIV, hepatitis B, and hepatitis c, an analysis of national health and nutritional examination survey between the years 1999-2010. Talk presented at: American College of Physicians; March 2015; Iselin, NJ. Accessed March 7, 2022. doi: 10.13140/2.1.3610.448

Sri Banerjee, MD, PhD, MPH, MAS, is a faculty member at Walden University in the School of Health Sciences. He is a clinical biostatistician and an epidemiologist in Leola, Pennsylvania.

TRANSCRIPTION:

Jessica Bard: Hello everyone. Welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network.

According to the Centers for Disease Control and Prevention, six in 10 Americans have a chronic disease. Dr Sri Banerjee is here to speak with us today about how inflammation bridges the gap between infectious disease and chronic disease.

Dr Banerjee is a faculty member at Walden University in the School of Health Sciences and a Clinical Biostatistician and Epidemiologist in Loyola, Pennsylvania. Thank you for joining us today. We're talking about your team's analysis: Inflammatory markers associated with disease progression of HIV, Hepatitis B, and Hepatitis C, and Analysis of National Health and Nutritional Examination Survey between the years of 1999 and 2010. Can you please tell us how this analysis came about?

Sri Banerjee, MD, PhD, MPH, MAS: Sure, Jessica, thank you for that question. And that's a really interesting thing to be thinking about when conceptualizing a research topic. So back when I had actually been seeing patients in an HIV clinic, repeatedly I saw was that there was more patients with chronic conditions than any sort of infectious disease concern. So what I mean by that, let me explain that to you a little bit more. So people ... I saw patients that instead of having a conversation in the clinic focusing around the triple therapy and all of the antivirals, more of the conversation was around managing chronic conditions like hypertension, diabetes, chronic kidney disease, things like that. So myself, and the Chief Resident at the time at the University of Maryland, and also my Committee Chair from Walden University, we conceptualized this idea to try to look for common pathways between chronic conditions and infectious conditions.

Jessica Bard: So, can you get a little bit deeper here, and give us more of an overview of this analysis?

Dr Banerjee: Sure. I certainly can do that. So when we're thinking about how chronic diseases and infectious diseases, how they are affecting the body, well, at a very basic level ... Let's get into the cellular level. So when cellular injury takes place, one of the common reactions is inflammation. So this is one phenomenon that can connect and tie together chronic diseases and infectious diseases. So we got to thinking, what are the types of inflammatory biomarkers that may be indicative of this? And so we thought C-reactive protein might be one such inflammatory biomarker.

Jessica Bard: How does inflammation bridge the gap between infectious disease and chronic disease?

Dr Banerjee: Now that's a good question. So when we're thinking about inflammation and how to precisely really study that, how do you study where that gap is and how do you create a design, a methodological study design? That was the challenge. And so, we had several options. One option was to look at longitudinal outcomes. And while we had that option, we decided to look cross-sectionally. So what we did is we were looking for not only HIV, but also Hepatitis B and Hepatitis C. But the main focus, most of the respondents were individuals that had chronic HIV. And so these viral infection ... how they affect inflammatory biomarkers, this is what we were studying. So the independent variable or the predictor variable that we selected was chronic virus. And then the outcome variable was cardiovascular disease. So this is how we ended up studying this and ran a logistic regression model.

Jessica Bard: Do your findings add any value to the current predictive scoring diagnostic systems?

Dr Banerjee: Jessica, that's a good question. And I think one that really needs to be looked at because ... You're right. Currently, there are so many risk scoring systems with the diagnostic equations. One such equation that I've used in a lot of my research is the Cockcroft-Gault equation. And so this equation actually has several predictors like creatinine, age, and others. But in some ways, there has been some research that shows that inflammatory biomarkers and tracking some of these biomarkers within predictive scores may actually add information to what is already available.

Jessica Bard: What are the gaps in this research?

Dr Banerjee: That's a really good question. Jessica, when you do research, there's always room that you can build on. And here is a situation where the findings were really interesting. So we actually did see when there was C-reactive protein, there was a stronger association between chronic virus and cardiovascular disease. So that means that we really need to look further into understanding what role C-reactive protein precisely plays in the development of chronic diseases. So one analysis that I think should be run as a follow-up is instead of, like I said, an outcome variable being cardiovascular disease, if we replace that with cardiovascular mortality.

And so, this analysis was run in the National Health and Nutritional Examination survey between the years of 1999 and 2010. And so, again, the years still are relevant. The findings are still relevant today. And so the follow-up study can be from this, that there's actually information currently available for December 31st, 2015. So all of these respondents can actually be followed up through all of these years. So that was a gap in this study, and I think it can be addressed by conducting a follow-up study.

Jessica Bard: What would you say are the key take-home messages from our conversation today?

Dr Banerjee: One key take0home message, I think as we are collectively, as a population, trying to understand not only how to better manage infections, how to better manage chronic diseases, we're also trying to figure out how to recover from the pandemic. So from COVID-19, there's also a development of long COVID, how various organs are affected. What HIV does is even though the immune system is actually not being affected as much because of antiretrovirals, but what HIV is doing, it's still causing damage at the cellular level in the kidneys. So the nephrons are getting damaged. And so some of these pathophysiological outcomes may be common to COVID-19 too. So as we're trying to understand the impact, I think it's important to see how this is relevant to other current viruses as well. And furthermore, I think it's important to keep in mind that inflammatory biomarkers like C-reactive protein can add really important information to what predictive scores currently provide. So those are the two main key take-home messages.

Jessica Bard: Is there anything else that you'd like to add today?

Dr Banerjee: No, that's all.

Jessica Bard: Well, thank you very much for your time. I really appreciate it.

Dr Banerjee: Thank you