Current Research Studies
Dr. Lo Re currently serves as Principal Investigator on the following research studies:
HIV and Aging Mechanisms for Hepatocellular Carcinoma
This grant will utilize the unique data of the Veterans Aging Cohort Study to conduct a series of epidemiologic and pathologic analyses to discover how factors specific to aging with HIV infection interact with conditions associated with liver injury in the general population for the development of hepatocellular carcinoma (HCC). Aim 1 will evaluate the risk of HCC associated with polypharmacy and current/cumulative use of antiretroviral drugs and determine how these alter HCC histology. Aim 2 will examine if cumulative exposure to immune deficiency, immune activation, and HIV viremia increase risk of HCC or alter HCC histology among HIV+ patients on ART, after accounting for traditional HCC risk factors (e.g., viral hepatitis, alcohol). Finally, in Aim 3, we will evaluate both HIV+ and uninfected persons to determine if obesity and diabetes mellitus, which can each promote hepatic steatosis, inflammation, and fibrosis, have a differential association with risk of HCC or alter HCC histology differently.
Funding Source: National Institutes of Health (NIH)/National Cancer Institute (NCI) R01
Changes in Bone Quality, Sarcopenia, and Fat Distribution in HIV/HCV Patients after HCV Therapy
HIV/hepatitis C virus (HCV) coinfection is associated with sarcopenia, visceral adiposity, hepatic steatosis, bone fractures, and insulin resistance, all of which contribute to morbidity and mortality in this group. This clinical research study will enroll three cohorts of patients: 1) HCV treatment-naïve HIV+/HCV+ coinfected patients initiating direct-acting antiviral (DAA) therapy, 2) treatment-naïve HCV+ monoinfected patients initiating DAA therapy, and 3) uninfected persons. We will prospectively follow both HCV infected cohorts from the start of DAA therapy through 12 months after cure of HCV (18-month period) and the uninfected cohort over 18 months. Aim 1 will compare muscle mass (by dual-energy X-ray absorptiometry), muscle strength; MRI measures of subcutaneous, visceral, and intra-hepatic fat; and bone microarchitecture/strength (by high resolution-peripheral quantitative CT) across the cohorts at enrollment and evaluate the levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1) as determinants of these outcomes. Aim 2 will examine the effect of cure of HCV with DAAs on the cytokine and IGF-1 levels in HIV+/HCV+ and HCV+ patients and their associations with subsequent changes in muscle, fat, and bone compared to changes in uninfected persons over the same time. The completion of these aims will address critical knowledge gaps on the determinants (particularly inflammatory cytokines and IGF-1) of sarcopenia, fat alterations, and skeletal fragility in HIV+/HCV+ patients, yield fundamental information on the reversibility of the abnormalities after cure of HCV, and identify determinants of improvement in muscle, fat, and bone strength.
Funding Source: National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID) R01
Assessment of the Natural History of Coagulopathy in COVID-19
The purpose of this project is to describe the natural history of coagulopathy among COVID-19 patients. We will determine the 90-day incidence of arterial and venous thrombotic complications (evaluated separately) with COVID-19 and subsequent risk of death within 90 days of the event and evaluate patient characteristics present prior to COVID-19 diagnosis as risk factors for arterial and venous thrombotic events (evaluated separately). Additionally, we will compare the 90-day risk of arterial and venous thrombotic events (evaluated separately) between health plan members diagnosed with COVID-19 and those diagnosed with influenza.
Funding Source: Food & Drug Administration (FDA) Sentinel Initiative
Adherence and Completion of Hepatitis C Therapy (ACT-C)
This project aims to improve understanding of the perceptions of chronic hepatits C virus (HCV)-infected patients related to barriers and facilitators to completing the HCV continuum of care, by HIV status. We are conducting focus groups among patients in various stages of HCV treatment, and who have achieved HCV cure, to facilitate understanding of patients' thoughts, expectations, and experiences with HCV therapy.
Funding Source: PCOR Pilot Study Award