Meet the CIPHER grantees

Andrew Walker McCrary

Year awarded: 2017
Institution: Duke University
Research site: Moi Teaching and Referral Hospital, Kenya
Primary mentor: Winstone Nyandiko, Moi Teaching and Referral Hospital

Andrew Walker McCrary is a paediatric cardiology and global health fellow at Duke University. He is currently pursuing a Master of Science in global health to connect his research skills with the global health community.

More information on Andrew | Email

“The CIPHER programme allowed for the expansion of an otherwise small, limited-impact echocardiogram-based project into a large study directly addressing the impact of chronic inflammation on the cardiac function of these children. I look forward to this project’s contribution to the understanding and care of these children.”

Research project: Evaluating indicators of cardiac function in children living with human immunodeficiency virus

The issue

HIV-associated cardiomyopathy exposes children with the infection to tremendous morbidity and mortality. Traditional echocardiographic measures (i.e., ejection fraction, shortening fraction, or chamber dimensions) do not detect cardiomyopathy until late stages of disease. There is a critical need to determine HIV-associated cardiomyopathy risk through early detection. The lack of methods to detect early myocardial dysfunction and inflammatory markers that determine risk are major barrier for outcomes and treatment research.

The CIPHER project

The goal of Dr McCrary’s research project is to address major scientific gaps in characterizing, preventing and treating HIV-associated cardiomyopathy. The objective is to determine the association of serum biomarkers, measures of cardiac function and HIV RNA levels in children with perinatally acquired HIV. The central hypothesis is that risk of risk of early cardiac dysfunction can be defined in terms of HIV clinical parameters, including viral load, ART, CD4 count and serum biomarkers (b-natriuretic peptide or BNP).

This research will expand the impact of a Duke Global Health Pathway project by providing pilot data to support further research in HIV-associated cardiomyopathy outcomes and treatments. It will:

  • Characterize a large cohort of children with perinatally acquired HIV on ART.
  • Relate echocardiograms assessment of cardiac function to patient-specific factors, i.e., same-day viral load value, viral load history, inflammatory marker values and BNP levels.

The impact

Dr McCrary’s study will explore the high-priority target area of HIV-associated cardiac co-morbidities and lead to enhanced understanding of the relationship between cardiac function and a serum biomarker (BNP) as a screening tool. Ultimately, this may yield insights into preventive and therapeutic approaches for HIV-associated cardiomyopathy in children.