The Bronx is home to more than 27,000 people living with HIV, the majority of whom are Black or Hispanic men. People living with HIV have an increased risk for depression and substance use, which in turn can make adhering to daily antiviral treatments difficult, negatively impacting both quality of life and overall health.
Now, the National Institutes of Health (NIH) has awarded researchers at Albert Einstein College of Medicine and Montefiore Health System two five-year grants totaling $7.6 million to study the structural and chemical changes in the brains of people living with HIV, depression and cannabis use disorder.
“Given the health disparities associated with both a mental health diagnosis and HIV-positive status, we’re hopeful our findings will serve as an important step in advancing health equity in the Bronx and around the country,” said Dr. Vilma Gabbay, co-director of the Psychiatry Research Institute at Montefiore Einstein and co-principal investigator on both grants.
Cannabis Use and Depression in People with HIV
The first research project, funded by a five-year, $4 million grant, will enroll 280 people ages 18-34 who are living with HIV. Some of the participants will have depression and regularly use cannabis. Investigators will use neuroimaging, including functional MRI, to examine brain circuitry related to reward and pain to better understand their links to depression and substance use disorder in this population. Principal investigators on the grant are Gabbay, Dr. Anjali Sharma, associate professor of medicine at Einstein and an internist and infectious diseases specialist at Montefiore; and Dr. Joanna Starrels, associate professor of medicine at Einstein and an internist and addiction medicine specialist at Montefiore.
“Our collaborative project involves experts in depression, HIV, addiction medicine, and neuroimaging, who will investigate the role of neural mechanisms to learn about the connection between cannabis use and depression in people living with HIV,” said Gabbay, who is also associate professor of psychiatry and behavioral sciences in the Dominick P. Purpura Department of Neuroscience at Einstein. “We hope to identify specific biomarkers of depression and develop better treatments.”
Understanding Depression in People Living with HIV
The second project, funded by a five-year, $3.6 million grant, will examine how the immune system, brain circuits and neurochemicals interact in people living with HIV. Investigators, led by Gabbay and Sharma, who co-chair the HIV and Mental Health Scientific Working Group for the Einstein-Rockefeller-CUNY Center for AIDS Research, hope to untangle this complex system to understand why these individuals are more vulnerable to depression.
The Einstein-Montefiore researchers believe that when the central nervous system (CNS) becomes inflamed by HIV, it results in two adverse effects: chemicals called free radicals injure nerves of the CNS and levels of gamma-aminobutyric acid (GABA) — a neurotransmitter known to have a calming effect — are reduced. These neurochemical changes are believed to cause depression.
“If we can confirm that this chain of events leads to depression,” Gabbay said, “We may be able to devise treatment strategies that can ward off depression in people infected by HIV — perhaps by inhibiting the inflammatory proteins that accompany HIV infection.”
Researchers will enroll 300 people living with and without HIV. At the start of the study, participants will be tested for levels of depression or anxiety, past psychiatric trauma, HIV treatment and levels of CD4+ T cells (a type of T cell affected by HIV infection). The tests will be repeated after six and 12 months.