Site Investigator Embraces "Whole-Body" Approach to HIV Treatment and Clinical Trial Design

Mar 30, 2016

Meet Dr. Grace McComsey

Grace McComsey, MD, is an Investigator and Professor of Pediatrics and Medicine and Chief, Pediatric Infectious Diseases and Rheumatology at our Case Western Reserve University Clinical Research Site in Cleveland, OH. She has worked with both children and adults living with HIV for over 15 years and during that time she has seen HIV treatment shift from being solely based on viral loads and CD4 counts to a more comprehensive and holistic approach. Dr. McComsey has embraced this “whole-body” approach where a clinician is equipped with a broad medical knowledge base allowing them to address a variety of needs of patients and study participants. In addition, she notes that she has found great value in considering all factors that contribute to successfully managing HIV and preventing known risk factors in the development of both mental and physical disease processes.

“Our study participants, like all people, are complex psychological and biological beings and they come to us with a wide variety of needs, beyond just HIV care,” said Dr. McComsey. “For example, nutrition and exercise can have a big impact on someone’s physical and mental health. In order for a person living with HIV to be successful in managing their health, he or she must receive guidance on more than just treating HIV.”

Dr. McComsey is also passionate about the research she conducts surrounding stigmatizing fat changes that not only affects quality of life but also increases risk of cardiovascular disease (CVD), diabetes, and other chronic conditions seen in patients living with HIV. Although research has come a long way in understanding the connection between alterations in fat tissue and HIV itself, as well as the drugs used to treat HIV, there is still much to learn about how to prevent these co-morbidities. Additionally, Dr. McComsey believes that the future of clinical trial research in managing HIV and metabolic complications should focus on more than just developing new antiretroviral medications and finding a cure for HIV. She believes it is increasingly important to develop, test, and implement strategies and interventions that will help people with HIV live the healthiest and fullest life possible.

“We know that people living with HIV who take antiretroviral medications have increases in visceral fat and in CVD, which is one of the top causes of death in people taking HIV medications with good adherence,” said Dr. McComsey. “We are closer than ever to a fully equal life expectancy between people living with HIV compared to those without HIV and taking control of fat and heart issues will likely further close this gap in life expectancy.”

HIV and the inflammation that comes with the virus can have devastating effects on the heart, the gut, the nervous system, muscles, fat, and other parts of the body. Dr. McComsey suggests that caring for a patient living with HIV requires a holistic “whole-body” approach to healthcare. This involves considerations including lifestyle choices, cardiovascular health, gastrointestinal health and psychiatric health. In addition, she notes that having undetectable viral load and high CD4 should be the minimum, not the only goal of successful HIV treatment.

One mentor that has shaped Dr. McComsey’s view on the importance of clinical research is Michael Lederman, MD, Professor of Medicine at Case Western Reserve University School of Medicine and University Hospitals of Cleveland. She learned from Dr. Lederman early in her career that if you want to be successful in research, you have to “eat, drink and dream research.” When she was younger, she was skeptical about his advice, but the current (older and wiser) version of her is convinced Dr. Lederman was absolutely correct.  It is clear that the two share a mutual respect of one another. 

“Grace is one of the most efficient, effective and productive researchers I have ever known. Not only is she is passionate about her work, she is also dedicated to her patients and a dynamic role model and mentor for young researchers,” said Dr. Lederman. “Grace has made many early and sustained landmark contributions to our understanding of the metabolic and inflammatory consequences of HIV infection and their role in the morbidities of HIV infection.  She’s a star!”

Regardless of the specific research project, Dr. McComsey’s body of work continues to characterize the role of inflammatory markers on heart disease in chronic diseases such as HIV. She encourages all ACTG Network researchers to take the time to understand the role of inflammatory processes in order to understand the intersection of multiple diseases. She also wishes to remind her fellow researchers that fat may be playing a major role in the heightened systemic inflammation in patients and study participants and that means everyone should care about fat, not just those working in this specific area.

In closing, Dr. McComsey also has an important message to patients and study participants living with HIV:

“Take great care of yourself, eat healthier and exercise as you are at an increased risk for diabetes and heart disease. We can beat HIV itself but we need you to be extra diligent in living a healthy life. We know that adequate exercise, a balanced diet, and a positive mental attitude are essential to preventing some of the long-term damage caused by HIV, but we still have a lot to learn and we need your help. Your experience and participation is invaluable to the clinical trial research conducted across the ACTG Network!”