Baylor Epidemiologist Receives NIH Career Development Award to Study Effect of Cannabis Use on Treatment Outcomes for Patients with HIV

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by Blake Thomas, Research Project Manager, Baylor Office of the Vice Provost for Research

WACO, Texas (Dec. 13, 2019) – Emeka Okafor, Ph.D., assistant professor of epidemiology in public health at Baylor University, has received a career development grant from the National Institutes of Health to study the effects of drug use, particularly cannabis, on treatment outcomes of patients with HIV.

The Mentored Research Scientist Award (K01) from the National Institute on Drug Abuse is a five-year grant that gives promising, early-career researchers the opportunity to build on their existing expertise and develop skills in a new methodology or area of study under the guidance of one or more senior faculty mentors. The grant, totaling more than $650,000, will provide Okafor with guidance in conducting clinical research, developing substance use interventions for vulnerable populations and measuring the links between substance use behavior and biological changes.

Okafor’s interest in using data to measure health and improve treatment began when he was an undergraduate student at the University of Lagos in his home country of Nigeria. He credits his father, a statistics professor at the university, with sowing the seeds of curiosity that would later lead him to a career in public health research.

Improving population health

“My dad used to have public health magazine subscriptions, and I would read about public health issues such as the prevalence of tuberculosis, HIV/AIDS, malaria and other things,” Okafor said. “That got me interested in how you use quantitative methods to understand health outcomes and behaviors in populations and how we can use that information to make policy, change behaviors and improve population health.”

Some of those magazines provided statistics about HIV/AIDS in Nigeria and the links with substance use. While volunteering in a clinic in Nigeria, Okafor met some HIV patients who had problems with substance use. When he came to the United States for graduate school in public health, he saw similar behaviors and patterns of drug use among American HIV patients.

“I realized that if we are to reduce HIV infections and get and retain people into treatment, we need to figure out a way to address substance abuse among those patients,” he said.

Recent advances in HIV treatment have provided patients with longer life expectancy, but those same treatments often cause side effects that can make day-to-day life miserable, according to the National Center for Biotechnology Information. Some patients experiment with cannabis to self-medicate these side effects as well as the symptoms of HIV, Okafor said. But little is known about how it may impact the effectiveness of viral suppression therapies and how it could impact mood symptoms and pain management and other outcomes relevant for persons with HIV.

“When you ask HIV patients why they use cannabis, they say it is to help their pain, nausea or side-effects from medication, while some report using recreationally,” Okafor said. “But we don’t know if that helps or hurts them. There are very few clinical trials that have been done to say whether cannabis helps pain or nausea for patients living with HIV. The question is: what basis is there for patients to use cannabis if we don’t know if it helps or hurts them?”

Challenges ahead

To answer this, Okafor and his research team will recruit patients with HIV who use cannabis and use blood tests to measure biomarkers of inflammation, viral load and CD4 count – a measure of cells in the blood that the HIV virus kills. Participants will be asked to discontinue their use of cannabis before having the same biomarkers measured again, allowing Okafor and his team to assess the effect of cannabis use on the patients’ HIV treatment.

One challenge facing researchers is determining how much of the two main chemical constituents in cannabis is present in a study participant’s body.

“Someone might say ‘I smoked three joints,’ or ‘I ate one cannabis brownie,’ but if we don’t know the actual concentration of THC and CBD in those products, we can’t draw good conclusions,” Okafor said.

Researchers will use sophisticated blood tests to measure more accurately THC and CBD concentration in a patient’s blood. These data, he said, will help to guide future studies determining whether there is a threshold of concentration that changes the effect.

Okafor will be mentored by a number of faculty with experience in public health, clinical research with vulnerable populations, HIV studies and statistical analysis. His primary mentors are Joyce Smith, Ph.D., Louis A. Faillace Professor and director of the Center for Neurobehavioral Research on Addiction (CNRA) in the department of psychiatry and behavioral sciences at the University of Houston, and Steve Shoptaw, Ph.D., a licensed psychologist and professor in the UCLA departments of family medicine and psychiatry and biobehavioral sciences. Smith also directs the lab in Houston, where Okafor will conduct the clinical portion of his research.

Okafor came to Baylor and its department of public health in Robbins College of Health and Human Sciences following a post-doctoral appointment at the Center for HIV Identification, Prevention and Treatment services (CHIPTS) at UCLA. He says that Baylor is a natural fit for him and a perfect institution to study important issues of public health.

“Baylor is a place that feels like a home,” Okafor said. “My belief is that we’re only alive for a short period of time, so our goal is to contribute any way we can. I was looking for a place that embodies that belief and I think Baylor does that through its Christian values.”

“As Baylor continues our progress to become an R1 Christian research university, the important work of Dr. Okafor significantly advances this effort,” said Rodney G. Bowden, Ph.D., dean of Robbins College and Brown Foundation Endowed Chair. “His research in vulnerable and underserved populations is an extension of our Christian mission, increases our research expenditures, provides more mentorship experiences for students and helps bring new information to the classroom. Dr. Okafor is a seminal addition to our Baylor faculty in Robbins College and public health.”

ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian University and a nationally ranked research institution. The University provides a vibrant campus community for more than 17,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 90 countries to study a broad range of degrees among its 12 nationally recognized academic divisions.

ABOUT ROBBINS COLLEGE OF HEALTH AND HUMAN SCIENCES AT BAYLOR UNIVERSITY

The Robbins College of Health and Human Sciences at Baylor University was established in 2014, a result of identified priorities for strengthening the health sciences through Baylor’s strategic vision, Pro Futuris, and the University’s Illuminate strategic plan. The anchor academic units that form Robbins College – Communication Sciences and Disorders; Family and Consumer Sciences; Health, Human Performance and Recreation; Public Health; and Division of Health Professions – share a common purpose: improving health and quality of life. The College’s curricula promotes a team-based approach to transformational education and research that has established interdisciplinary research collaborations to advance solutions for improving quality of life for individuals, families and communities. For more information, visit www.baylor.edu/chhs.