VIGH explores nutrition-related mortality in Zambia

Doug Heimburger, M.D., M.S.

Douglas Heimburger, M.D., M.S leads the Vanderbilt Institute for Global Health’s nutrition-related initiatives in collaboration with partners in Lusaka, Zambia.

In 2006 while on sabbatical in Zambia at the Centre for Infectious Disease Research, Dr. Heimburger became enchanted with this sub-Saharan African nation. According to WHO estimates from 2007, 15% of Zambia’s 13 million people were HIV positive. A high mortality rate among underweight Zambians initiating antiretroviral therapy (ART) caused Dr. Heimburger to begin his research on the effects of ART on undernourished HIV-positive people. His desire to explore links between nutrition and antiretroviral therapy led to an NIH-funded, R21 grant focused on nutritional causes for early ART mortality in Zambia.

Mr. Dixon Matulula (Clinical Officer hired for NEMART study), Dr. Paula Seerebutra (UAB resident, now UAB ID fellow), Ms. Bernadette Nyemba (CIDRZ Senior Research Nurse), Dr. Christopher Nyirenda (Head of Internal Medicine at Ndola Central Hospital/ Copperbelt University School of Medicine in Zambia, and now a Vanderbilt MPH Student), Doug Heimburger, M.D. (PI, Vanderbilt Institute for Global Health) 

In 2008, he began collaborating with Vanderbilt Infectious Disease Fellow, Dr. John Koethe and a team of researchers at the University of Zambia. Together, they discovered that the level of phosphate in the bloodstream is an independent predictor of early mortality among patients starting ART. A desire to explore this further generated collaborations with additional investigators at the London School of Hygiene & Tropical Medicine, and Barts and The London School of Medicine and Dentistry. They were awarded funding from the European and Developing Countries Clinical Trials Partnership to determine whether nutritional supplementation could offset the increased risk of mortality in undernourished HIV patients initiating ART. This randomized, placebo-controlled clinical trial is currently underway in Zambia and has led to investigations of the mechanisms of the nutritional supplement’s effects. Additional awards from NIH’s Fogarty International Center and Vanderbilt University’s Center for AIDS Research (CFAR) supports Vanderbilt Drs. Michael Bestawros and Ashley Canipe to elucidate these mechanisms as they pertain to the gastrointestinal and cardiovascular systems.

In Zambia, Drs. Takondwa Chidumayo and Dominique Chimanuka are participating in this investigation as part of their advanced medical training. Dr. Christopher Nyirenda’s work as a member of the research team since 2006 and physician at the University of Zambia led to his matriculation into the Vanderbilt MPH Program in Fall 2012.

This vibrant research on the nutritional aspects of mortality in Zambian adults with HIV/AIDS has ignited a fire in many budding researchers, and welcomes collaborations as they strive to decrease the mortality rate and improve the quality of life of people living with HIV in Zambia.