Fulbright Scholar from Rwanda studies HIV disorders at WUSTL

Eugene Mutimura, a lecturer at the Kigali Health Institute in Rwanda, is spending five months at the School of Medicine learning how to improve care for his fellow countrymen who suffer from the metabolic syndromes associated with HIV and AIDS.

Mutimura works with Kevin E. Yarasheski, Ph.D., associate professor of medicine, of cell biology and physiology and of physical therapy, and W. Todd Cade, Ph.D., instructor in physical therapy and medicine, learning several clinical research techniques that he will take back to the institute.

About 5 percent of all Rwandans are infected with HIV, Mutimura said, although estimates are higher in women, youth and adults in their 30s. The disease is also more prevalent in urban areas, he said.

In addition to antiretroviral treatments, the World Health Organization’s first-line treatment regimen, Mutimura and his colleagues are involved in research to assess whether lifestyle modifications, such as exercise training and dietary modifications, can improve metabolic abnormalities in patients with HIV who are being treated with antiretroviral therapies. This is part of his objective of the Fulbright scholarship.

While the medications have resulted in tremendous improvements in morbidity and mortality in individuals with HIV, they have serious side effects, including insulin resistance, high blood cholesterol and blood fats, an increase in fat in the abdomen and a loss of fat in the arm, legs, buttocks and face, known as HIV lipodystrophy syndrome.

The physical abnormalities contribute to further stigma in patients with HIV in Rwanda and other African countries where there are communal economic and social activities and the societies are more culturally sensitive.

In addition, those side effects can translate into accelerated heart disease and diabetes, Cade said.

Among the clinical research techniques Mutimura is learning at the medical school is the euglycemic hyperinsulinemic clamp technique, which Yarasheski said is “the gold standard” for quantifying glucose metabolism in humans.

“The clamp technique requires investigator oversight and frequent blood sampling over a six- or seven-hour period,” Yarasheski said. “But it’s straightforward enough that it could be done in Rwanda without consuming a lot of resources.”

Mutimura, a doctoral candidate at the University of Witwatersrand in South Africa, also is learning to use dual energy X-ray absorptiometry and magnetic resonance imaging to see where a patient stores fat on the body, which is a good determination of the extent of the metabolic effects of HIV and the antiretroviral drugs.

He also will study the impact of exercise training on the same patients.

The Fulbright scholarship has a wider impact than the opportunity for him to study at the University for five months, Mutimura pointed out.

“The program will help not only me,” he said. “It’s important that this becomes a cornerstone to train others and form new, wider partnerships.”

Mutimura said he hopes to establish a collaboration between the University and Rwandan medical and allied health professional schools such as the Kigali Health Institute.

“My most important objective is a partnership that is aimed at enhancing research and collaboration in training,” Mutimura said. “Rwandan students could come to the School of Medicine for training, and both medical students and investigators could come to Rwanda to improve research programs, which would benefit their professional experiences.”