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It was the fast-paced excitement of the intensive care unit that first inspired Dr. Engi Attia to pursue specialty training in Pulmonary and Critical Care Medicine, but as she dove deeper into the field, Dr. Attia found a passion for pulmonology, which encompasses a broad spectrum of pathophysiology. Now a senior fellow in the UW Division of Pulmonary and Critical Care Medicine, Dr. Attia integrates her longstanding interest in global health with pulmonary medicine. Dr. Attia first pursued her interest in international public health as an undergraduate at Rice University, and continued to explore this intersection across disciplines while, as an Internal Medicine resident at the University of Texas Southwestern Medical Center, she cared for HIV-infected patients whom she observed to have a marked burden of both infectious and non-infectious pulmonary diseases. In 2011, Dr. Attia volunteered at the Coptic Hospital in Nairobi, Kenya, providing medical care to HIV-infected patients living in extreme depravity, and recalls, “I was struck by the prevalence of pulmonary diseases in these extraordinarily different populations.”

It was only after she started her fellowship at UW that she learned of the decade-long collaboration between TREE and the Coptic Hospital that led to the creation of the Coptic Hope Center for Infectious Diseases, now one of the largest single site HIV clinics in Kenya. “I knew this was the opportunity I had been looking for to combine my interests in global health and pulmonary disease to learn about the etiologies, pathophysiologic mechanisms and risk factors of chronic lung diseases in resource-limited settings,” explains Dr. Attia. From there, her collaboration with TREE began, and chronic lung disease emerged as a TREE research focus. 

With TREE, Dr. Attia initially conducted a study using the robust Hope Center database, finding evidence to suggest increased respiratory abnormalities among adolescents with vertical mother-to-child transmission of HIV. This prompted development of a study to determine the prevalence of and risk factors for chronic respiratory symptoms and abnormal spirometry (a lung function measurement). Dr. Attia enrolled 450 HIV-infected individuals from the Hope Center, 55 of whom were adolescents with vertically-acquired HIV. Chronic productive cough, low oxygen saturation and abnormal spirometry, were significantly more frequent among adolescents compared to adults. A unique issue for these adolescents was that HIV infection, particularly if uncontrolled during critical periods of lung development, may confer greater risk for chronic lung diseases. It is increasingly recognized that many HIV-infected infants in developing countries are surviving to adolescence without antiretroviral therapy, and in such settings, the added risks of vertically-acquired HIV and limited access to antiretrovirals are coupled with exposure to highly prevalent risk factors for lung function impairment and respiratory symptoms, including indoor biofuel burning (such as charcoal, wood, plant/animal waste), pulmonary infections and malnutrition. In contrast, HIV-infected infants in high-income countries uniformly receive antiretroviral therapy, and chronic lung diseases are rarely described among adolescents.

Dr. Attia hopes that better understanding of these risk factors in low and middle income countries will result in improved lung health for children and adolescents through preventative and therapeutic interventions. “As HIV-infected individuals are living longer, they are experiencing an increasing burden of chronic comorbidities, including chronic lung diseases, which may result in greater disability and, even mortality. My hope is that in the short term, addressing these lung diseases in HIV-infected adolescents will allow these kids to keep up with their friends in soccer. In the long term, I hope these HIV-infected adolescents can grow into adults unhindered by the extra burden of lung disease,” explains Dr. Attia.

Dr. Attia’s innovative research is gaining broad recognition; this past December, she was recognized for her work by the Thrasher Research Fund, receiving a $25,000 Early Career Award. With this funding, she plans to further characterize lung pathology in the adolescent subset of her study population.