How Miller School of Medicine Researchers are Advancing HIV and Healthy Aging Research
Through the long-running MACS/WIHS Combined Cohort Study, Miller School investigators are examining how HIV affects cardiovascular, oral, mental and reproductive health as people age, while mentoring the next generation of researchers.
Key Takeaways
- MWCCS is a national longitudinal study examining HIV and health across the lifespan.
- University of Miami Miller School of Medicine investigators study cardiovascular, oral, mental and reproductive health, among other areas.
- Participants complete recurring health assessments that allow researchers to examine changes over time.
- The Miami team uses community engagement and a mobile research unit to help participants complete study visits.
One of the largest funded longitudinal research studies at the University of Miami Miller School also exemplifies the power of mentorship from one generation of scientists to the next.
Researchers in the MACS/WIHS Combined Cohort Study (MWCCS) aim to understand and reduce the impact of health conditions affecting people living with HIV as they age. As HIV/AIDS treatments progress, people living with HIV today are more likely to develop chronic diseases than AIDS-related conditions.
After securing a new round of more than $17 million in funding for the Miller School over six years, the Miller School MWCCS brings together diverse experts from specialties like cardiovascular health and infectious disease to behavioral health and oral health, among others.
“All the decisions are shared as a team. Each of us has our unique area of expertise to bring to the table, and it’s an honor to work together,” said Claudia Martinez, M.D., a principal investigator and professor of cardiovascular medicine at the Miller School.
What Is the MACS/WIHS Combined Cohort Study?
The Miller School is one of 13 clinical research sites for the MWCCS, which began in 1984 and was renewed for another six years in 2026. The study, then known as the Multicenter AIDS Cohort Study (MACS), started with men only in 1984, when HIV was first identified and associated with men. Researchers focused on understanding the disease, its causes and related infections.
It took nearly a decade before it was clear that HIV also made a big impact on women, leading to the Women’s Interagency HIV Study (WIHS) in 1993. In 2019, the National Institutes of Health combined the two studies into the MWCCS, a study of men and women.
After more than 30 years of studying the disease and decades of effective treatment, today’s research focuses on aging with HIV. Miller School researchers have been a part of the study since joining the WIHS consortium in 2012 and becoming a primary clinical research site for studying HIV’s effects among women in the South and then among men and women as part of the MWCCS since 2019.
Each of the study’s three principal investigators, Maria Alcaide, M.D., Deborah Jones Weiss, Ph.D. and Dr. Martinez, got involved in the study by knocking on a mentor’s door.
“We’re a good example of what happens when you bring different people to an interdisciplinary team, including mentees, to work together closely, grow and develop,” says Dr. Alcaide, a Miller School professor of infectious diseases with appointments in the Department of Obstetrics, Gynecology and Reproductive Sciences and the Department of Public Health Sciences.
Dr. Alcaide began her HIV research career with a small pilot study linked to the WIHS under the mentorship of Dr. Jones Weiss. She later received an NIH mentorship award and then a larger grant. Today, she’s also the principal investigator of the sister study, the STAR cohort, which is also a cohort study, but focused on reproductive-age women with and without HIV. Dr. Jones Weiss joined the study through another Miller School senior investigator, Margaret Fischl, M.D., who was a principal investigator of the Miami WIHS.
When the researchers realized the importance of studying cardiovascular disease in people living with HIV, they brought along Dr. Martinez, who also started with a pilot award within the study under the mentorship of Drs. Alcaide and Jones Weiss. Today, she’s one of the Miller School’s main funded investigators.
“We have many other junior investigators and we are working to help them grow by doing work with the cohort,” Dr. Alcaide said. “The beauty of this study is that it’s multidisciplinary.”
MWCCS touches so many areas of health, so researchers across the Miller School are interested in the findings.
“We’ve been able to really galvanize the involvement of scientists. The more who hear about it, the more who want to explore ideas using the cohort,” said Dr. Jones Weiss, a professor of psychiatry and behavioral sciences at the Miller School.
Why This Research Matters
As people with HIV live longer, researchers are studying how chronic conditions such as cardiovascular disease, oral health problems and mental health concerns affect health across the lifespan.
The MACS/WIHS Combined Cohort Study follows participants over time, allowing investigators to examine biological samples, health screenings, medical measures and survey responses across multiple areas of health.
At the Miller School, the study also connects investigators across disciplines, supports community-engaged research and helps generate new questions for future studies.
HIV and Chronic Disease
The cohort in Miami includes 280 men and 250 women and focuses on the impact of chronic conditions on people living with HIV, including heart, lung, blood and sleep disorders. The study is funded primarily by the National Heart, Lung, and Blood Institute, with 10 additional co-funding institutes.
More than 5,000 participants are enrolled in the longitudinal study across all research sites in the U.S. Participants undergo screening every six months to gather biological samples and conduct exams and surveys that measure everything from cardiovascular risk, liver function, frailty, oral health, sleep quality, gynecological health, malignancies and cognitive function, among others.
Researchers continue research to learn about the virus and develop new treatments, while also focusing on how people living with HIV suffer from other conditions at higher rates than the general population. For example, people living with HIV tend to age earlier and experience higher rates of cardiovascular disease, oral health problems, depression, anxiety and post-traumatic stress.
“This next phase of the study is driven by how HIV accelerates aging, because the cohort itself is aging,” said Dr. Jones Weiss.
What Can HIV Research Teach Us About Healthy Aging?
The study often has broad applications beyond people living with HIV.
“Through the lens of HIV, we’re learning about how to prevent and treat heart disease in everyone,” said Dr. Martinez.
Every research site collects the same data, but investigators focus on different areas.
“One of the things that we’ve made a priority here in Miami is how we incorporate practical cardiovascular measures,” said Dr. Martinez.
For example, one innovative cardiovascular risk screening conducted only in Miami and applicable to clinical practice is a digital thermal monitor, a portable vascular device, that measures longitudinal vascular health.
“When we looked at the preliminary data of the cardiovascular conditions in this population, we learned that 80% of the people had poor cardiovascular health, which is concerning because these are otherwise healthy people. But a simple measure shows the opposite,” said Dr. Martinez.
Participants identified with cardiovascular disease or any other condition during the study are referred to a specialist.
Another study, the CROWN study (Comprehensive Research on Oral and mental health among WomeN), identified a relationship between oral health and mental health in the Miami and Chapel Hill cohort, including a pronounced difference between men and women. Oral health was not a dominant issue among women living with HIV when they were younger, but it often becomes a problem as they age. The opposite is true in men.
Poor oral health may be linked to higher risks of infections, heart disease and other problems. Men have more mental health issues associated with poor oral health than women.
“I think part of it is related to substance use, because men were more likely to use amphetamines or cocaine, which really impacts your teeth,” said Dr. Jones Weiss.
Another cause is that antiretroviral therapy (ART) can decrease salivary flow, hindering chewing and swallowing and increasing the risk of dental caries.
Findings also showed that many of the women who are living with HIV benefit from social services available specifically for them, moreso than the men in the cohort and people who aren’t living with HIV.
“The programs in place are really making a difference in the lives of women who are often low-income and marginalized,” said Dr. Jones Weiss.
More than half of people living with HIV worldwide are women.
A large sub-study of MACS/WIHS at the Miller School launched in early 2026 as the second five-year phase of STAR (Study of Treatment and Reproductive Outcomes), a multi-center, longitudinal investigation of HIV and women of reproductive age in the southern United States. The STAR study grew out of a goal to focus on younger women’s reproductive health and childbearing, which weren’t addressed among the MWCCS. Dr. Alcaide leads STAR in collaboration with Drs. Jones Weiss and Martinez.
How Does Community-Engaged Research Improve Participation?
One study outcome the PIs are particularly proud of is their ability to recruit and retain participants. Miami is one of the highest enrollers in the cohort.
“We are located in an epicenter of the epidemic, so we have the opportunity to conduct the study in the right place at the right time, among a diverse population,” said Dr. Martinez.
A key way the scientists remove barriers to study adherence is by bringing HIV research directly to participants with the CONNECT mobile research unit. Parking the research bus in neighborhoods where study participants live allows researchers to raise awareness of the study and increase diversity among participants.
“We have participants that never come to do the visits onsite, and they only use a mobile unit,” says Dr. Alcaide.
Translational Research Benefits Everyone
The MWCCS study is longitudinal and does not provide treatment or interventions, but study participants and people living with HIV in general are directly benefiting from the findings. People in the study learn more about their health from their results and are referred to other practitioners when intervention is necessary. Findings also inspire more science.
“When we identify something that’s not being studied as part of the cohort, we propose new studies,” said Dr. Alcaide.
Overall, MWCCS research at the Miller School represents the best of translational research, where researchers from multiple areas are driven by a shared goal of directly improving people’s lives. Over the years, many of the guidelines for people living with HIV were developed as a result of findings from the study.
“We know that all components of health have to be taken into consideration so we can move the science forward, because if we only look at one of the many pieces, we won’t be able to improve health outcomes or make significant findings,” said Dr. Alcaide.
More from the Miller School of Medicine
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University of Miami Miller School faculty are recognized for their impact in research, innovation and leadership.
Dr. Ronald Desrosiers’ HIV research at the University of Miami explores gene therapy and broadly neutralizing antibodies.
University of Miami’s CFAR symposium showcased advances in HIV treatment, cure research and implementation science.
Tags: aging, AIDS, CFAR, Department of Psychiatry and Behavioral Sciences, Dr. Claudia Martinez, Dr. Deborah Jones Weiss, Dr. Maria Alcaide, HIV, HIV research, Infectious diseases, Miami Center for AIDS Research