Table 2.

Research priorities for non-communicable cardiovascular and pulmonary disease comorbidities in HIV in LMICs

Recommendation	Expected outcome	Potential existing resources	Potential research design	Major challenges
A. Epidemiological Research
1. Analysis of existing and novel epidemiological data	a. Identification of NCDs where HIV or ART plays a role in presentation, expression or severity of disease	Internationally-funded HIV treatment programs in LMICs NHLBI Centers of Excellence (COE) Program (see text for reference) Global Alliance for Chronic Diseases (GACD) (see text for reference) IeDEA networka	Longitudinal cohort studies	Lack of HIV- comparators
	b. Identification of NCDs for which HIV-infected persons represent a significant portion of the affected population	Existing disease specific cohorts (e.g., Heart of Soweto, THESUS-HF, BOLD) (see text for references) COE program, GACD network	Case-control studies identifying HIV- associations	HIV testing not a routine aspect of data collection
2. Incorporation of HIV and NCD data capture into existing population surveilance	a. Population-based estimates of disease comorbidity burden	National demographic surveillance systems INDEPTH networkb	Population-based surveillance	Cost Surveillance infrastructre
B. Mechanistic Studies
1. Collaborations to elucidate pathways by which HIV and ART impact NCDs	a. Selection of disease targets for which HIV-linked interventions (e.g., timing of ART initiation) can be expected to have significant favorable impact	LMIC centers with access to infrastructure to perform such studies	Pathologic inspection of target organs or target organ tissues accessible ex vivo (e.g., bronchoalveolar cells) Animal studies	Resources Infrastructure Access to tissues Appropriate animal models
C. Clinical Research
1. Health outcomes research	a. Optimized management of HIV/NCD comorbidities	IeDEA network Internationally-funded HIV treatment programs in LMICs(e.g. PEPFAR, Global Fund for AIDS, TB and Malaria) Monitoring and evaluation programs for HIV care	Randomized (cluster) trials of treatment strategies to establish best practices for specific regions	Monitoring and evaluation Poor health information systems
	b. Appropriate allocation of resources	(as above)	Embed cost-effectiveness studies into therapeutic and management strategy trials	(as above)
2. Close examination of the effect of ART on the condition	a. Ensuring the potential negative effects of ART on NCDs are minimized.	IeDEA network AIDS clinical trial group HIV/AIDS Clinical Trials Network (NIAID)(see text for reference) Birth cohorts in LMICs	Randomized trials and observational studies of ART regimens and NCD outcomes with close attention to ART regimens, viral load, markers of immune activation and inflammation.	Cost Poor health information systems

Abbreviations: NCD, non-communicable diseases, LMIC, low- and middle-income countries; ART, antiretroviral therapy; NHLBI, National Heart, Lung and Blood Institute; NIAID, National Institute of Allergy and Infectious Diseases

^aInternational Epidemiologic Databases to Evaluate AIDS, www.iedea.org

^bInternational Network of field sites for continuous Demographic Evaluation of Populations and Their Health in developing countries, www.indepthnetwork.org