Colleen Kelley, MD, MPH, assistant professor of medicine at Emory University’s School of Medicine and Rollins School of Public Health and former ACTSI KL2-Mentored Clinical and Translational Research Scholar, recently received two National Institute of Health (NIH) R01 Research Project Grants. Kelley is a translational research investigator who specializes in biomedical HIV prevention interventions, including pre- and post-exposure prophylaxis and HIV vaccines.
Sexually Transmitted Infections (STI) and Implications for HIV Transmission and Prevention
Kelley’s first R01 grant is focused on addressing a major disparity in current HIV research. Most HIV transmission studies focus on vaginal transmission or use non-human primate models to infer findings to humans, but men who have sex with men account for nearly 67% of new HIV infections in the U.S. (2014). Approximately 70% of HIV transmissions among men who have sex with men occur via exposure to the rectal mucosa, and this route of HIV transmission has been understudied to date.
Asymptomatic rectal STIs, such as gonorrhea, chlamydia, and syphilis, are very common among men who have sex with men and can facilitate HIV transmission. However, little is known about the biologic and immunologic effects of these infections on the rectal mucosa. For men who have sex with men who are HIV seronegative, inflammation and mucosal injury associated with the STI could lead to enhanced rectal mucosal susceptibility. For HIV positive men who have sex with men, inflammation associated with a rectal STI could lead to increased HIV replication and risk of transmission to HIV negative partners. In addition, there appears to an increased risk of HIV acquisition even after treatment of the STI with antibiotics for which the biologic mechanism is not yet elucidated.
Kelley’s study will examine the rectal mucosal immune milieu, including the innate and adaptive cellular responses, the transcriptome, and the microbiome in the setting of asymptomatic rectal STI. She will also examine how antibiotic treatment of the STI alters the immune environment. These studies will lead to a deeper understanding of HIV transmission in the rectum and may lay the groundwork for the design of future biomedical prevention interventions.
Understanding Rectal HIV Transmission among At-risk Men who have Sex with Men: Age, Intercourse, and Mucosal Injury
In the second R01, Kelley will build upon her previous studies to examine how age and mucosal injury influence HIV transmission in the rectum among men who have sex with men. Epidemiologic trends show high rates of HIV transmission among young men who have sex with men, and reasons for these trends are not clear. While sexual behavior and networks play a major role in ongoing HIV transmission, it is not yet known if there is a biologic component to the high rates seen among young men who have sex with men.
Kelley’s study will examine how factors like age at debut of receptive anal intercourse (RAI) and frequency of RAI over time influences HIV transmission. An improved understanding of rectal HIV transmission among men who have sex with men will inform future biomedical prevention interventions. Kelley’s work is also supported by the Emory Center for AIDS Research.
The goal of the Atlanta Clinical & Translational Science Institute (ACTSI)’s KL2 program is to support career development of junior faculty (MD, PhD, or MD/PhD) from a wide variety of disciplines at the ACTSI partner institutions, Emory University (Emory), Morehouse School of Medicine (MSM), and Georgia Institute of Technology (Georgia Tech). The KL2 program provides opportunities for didactic and mentored research training for KL2 scholars with the goal for our scholars to become independently funded and successful clinical and translational research investigators.
ACTSI is a city-wide partnership between Emory, MSM, and Georgia Tech and is one of a national consortium striving to improve the way biomedical research is conducted across the country. The consortium, funded through the National Center for Advancing Translational Sciences (NCATS) as one of the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.