Up Close: Rupak Shivakoti

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Improving Health of HIV-infected Mothers and their Infants in India 

Rupak Shivakoti’s work takes guts—no joke. “Our team is looking at whether inflammation, diet, and the gut microbiome of pregnant women are predictors of preterm delivery, low birth weight, and small-for-gestational age in India,” Dr. Shivakoti explains. India has the highest burden of preterm birth and the third highest burden of HIV, and infants who have HIV+ mothers are more likely to be born preterm.

“We want to identify factors during pregnancy that are predictive of problems during birth and early childhood so we can recommend interventions that are affordable and sustainable—such as anti-inflammatory therapeutics, probiotics, dietary modifications, etc. The ultimate goal is healthier moms and babies.”

The study—Maternal Inflammation, Diet, and Gut Microbiome in HIV: Impact on Infant Outcomes—is looking at these various factors during pregnancy and then monitoring how they affect birth outcomes and infant health for 2 years. “By following babies until age 2, we will be able to look at a host of outcomes beyond birth that extend into the early years of childhood—issues such as infant growth and vaccine responses.”

Both HIV-infected and uninfected pregnant women from Pune, India, are participating. According to Shivakoti, “The research questions pertain to both populations, and by including the non-infected group, we can gain valuable insight on the role that HIV plays in health outcomes.”

Very Few Studies on Pregnant Women

While past studies have looked at nutrition, inflammation, and gut microbiome in adult populations and how they affect HIV disease outcomes such as disease progression and mortality, there are very few studies that have been conducted on pregnant women to determine the effects on infant health. “Our work focuses on the inter-relationship of these various factors, in an especially vulnerable population: HIV-infected pregnant women and their infants. The setting of India, with its unique diet and gut microbiome, makes it even more interesting, as very little is known, especially how they differ during pregnancy or by HIV status.”

Immunity Studies Begun in Lab Now Focus on Populations

Dr. Shivakoti joined CCGHE in summer 2013 as a post-doctoral fellow. “My doctoral studies were based in the laboratory, where I studied immune responses to infectious diseases and vaccines. After completing my education, I wanted to continue doing research on infectious diseases, but focus on population-based studies in resource limited settings. Dr. Amita Gupta’s research group was a great way to do such research where I was able to study the intersection of immunity, nutrition, and infectious diseases in a multi-country setting. It is very rewarding work to try to improve public health in areas of greatest need and often in the most vulnerable populations.”

Shivakoti is a CCGHE Ujala Scholar who has received numerous NIH-funded grant and scholarship awards for his research. Partner institutions for the study are Byramjee Jeejeebhoy Government Medical College (Pune, India); National Institute for Tuberculosis Research (Chennai, India); National Centre for Cell Science (Pune, India); University College Cork, Ireland; Johns Hopkins Bloomberg School of Public Health (Baltimore, MD); University of Maryland (Baltimore, MD).