YuLin Zhen, Photography Editor

A new center at Yale’s medical school dedicated to discovering strategies for healthy aging for patients with HIV is set to launch with the support of a five-year grant from the National Institute on Alcohol Abuse and Alcoholism.

The Aging Well with HIV Through Alcohol Research and Risk Reduction and Education — or AWAR3E — Center is led by Amy Justice MED ’88, a professor of internal medicine and public health at the School of Medicine; Julie Womack NUR ’94 GRD ’08, an associate professor of nursing at the School of Nursing; and Vincent Lo Re, a professor of medicine and epidemiology at Rutgers University’s Robert Wood Johnson Medical School.

“There are more people aging with HIV now than ever before, thankfully, because we have therapy to suppress the virus and to extend people’s life expectancy, and they are subject to a greater risk or vulnerability for a number of medical conditions that are associated with aging, whether it be cancer, cardiovascular disease, liver disease, diabetes, etc,” Justice said in an interview. 

“So we want to understand why that is both in terms of being able to help manage aging with HIV better, but also to gain insights into aging more generally as well,” she added.

Justice explained that while both people with HIV and people who are aging have immune dysfunction, HIV causes “immune dysfunction with a vengeance.” 

She said many HIV-infected people continue to use alcohol and other substances, are co-infected with hepatitis C and may be socioeconomically disadvantaged — all of which are factors that could contribute to premature aging, and that the center will explore to help guide designs of future health interventions.

The center builds on the foundation created by the Veterans Aging Cohort Study, or VACS, Consortium, which was originally founded by Justice to study the impact of alcohol use on aging in HIV-infected and uninfected individuals. VACS provides access to over two decades of longitudinal data representing as much as 13.5 million people from the national electronic health record data system.

Justice said the team spent years learning how to use and interpret the data from VACS and, in the process, developed a network of experts in different fields to support the project. Womack has extensively studied preventing falls and fractures among people aging with HIV, and the team also has world experts on liver disease, neurologic disease, heart disease and cancer.

As a general internist who has experience studying multiple research domains, Justice noted that having a less specialized position also has its benefits.

“I think it doesn’t hurt for me to be aware that I’m not an expert in any of these areas, because I can listen to the expertise of others,” Justice said.

For Womack, one key challenge was the process of writing the grant for the center. To get each draft finished on time, everybody on the team had to agree to a timeline and meet regularly throughout the grant’s development.

Justice said the team started work on the grant in January 2024. Every member would produce a draft of their project, and then the entire team would discuss questions and goals with one another to make each iteration of the grant more and more consistent.

Despite the challenges of preparing the grant itself, Womack said the experience of working with an interdisciplinary team has been rewarding.

“We have the evaluation and dissemination core, and we’re bringing in providers. We’re bringing in people from different HIV related agencies. We’re bringing in people who represent the HIV community. You know, just the opportunity to work with all these different people who have all these different interests and all these different lenses on the problem was just fascinating,” Womack said in an interview with the News.

The grant is particularly centered on determining whether or not stress from different sources such as alcohol use and socioeconomic deprivation contributes to premature aging through inflammation.

According to Justice, a lot of premature or adverse aging has been associated with chronic inflammation in people with or without HIV. She further noted that obesity, bad diet, lack of exercise, substance use and stress are all factors that can drive chronic inflammation.

One of the team’s projects focuses on biological markers of stress and inflammation in people living with HIV. Even those who have their HIV managed with treatment can have tiny traces of the virus — known as viral reservoirs — lingering in their body, and the study seeks to determine whether these reservoirs contribute to stress and inflammation.

Another project seeks to better understand how aging-related health problems like falls, fractures, dementia and hospitalization might be linked to socioeconomic disadvantage.

When asked about the team’s goals for the center, Lo Re emphasized the importance of research and mentorship.

“From my standpoint, aside from the terrific science that we will advance with our new center, one of the big benefits of our new center is that it will nurture the generation of significant research in alcohol-HIV/AIDS research, provide valuable mentorship to early-stage investigators, and attract scientists new to alcohol-HIV/AIDS research,” Lo Re wrote in a statement to the News.

Womack also voiced excitement for another focus of the center: widely sharing its findings from each project.

“Actually one of the core groups within this grant is a group of people who are going to look at all the different projects and give advice and input about, how do you get this information out there? Who do we need to get this to?” Womack said.

The team hopes that this core will help inform patients, clinicians, providers and organizations of the results from their research.

According to 2022 estimates from the Centers for Disease Control and Prevention, approximately 1.2 million people live with HIV in the United States.