Category: National Heart and Lung Institute

From Britpop to breakthroughs: Reflecting on 30 years of HIV testing and treatment

Born on what would eventually be recognized as World AIDS Day in the 1970s, Dr Mike Emerson, now affiliated with the National Heart and Lung Institute, relocated to vibrant London during the early 1990s amidst the fervour of the Britpop era. In the backdrop of Blur and Pulp melodies, 1990s London faced the AIDS crisis. Three decades later, he is at the helm of a team investigating cardiovascular ailments in people with HIV. In this piece, Dr Emerson reflects on the advancements in HIV diagnosis and therapy, and reiterates the ongoing importance of  National HIV Testing Week. 


I was born on what was to become World AIDS day way back in the 1970s, and moved to the big smoke in the early 90s. London was exploding with Britpop excitement, and in the absence of mobile tech, we went out every night to the sounds of Blur and Pulp. 90s London was also the epicentre of the UK’s bit of the global AIDS crisis. People in their early 20s, as I was, were dying (of ignorance the government told us). I quickly learnt not to hold birthday celebrations in Soho; celebrating and mourning young friends and sons don’t mix well. Exactly 30 years later, I lead a team investigating cardiovascular disease as people live with HIV for decades and succumb to the diseases of old age. This week is HIV testing week, so it’s a good time to reflect on how far we have come and remind ourselves of the importance of HIV testing. 

Back in 1981, a couple of obscure articles noted incidences of fatal pneumonia and rare skin cancers in otherwise healthy young American men. Oddly, these men were all gay. Within months, there was an explosion of terrifying fatal illness amongst the gay communities of New York, San Francisco and, not far behind, London. People became infected with HIV following blood transfusions, and babies were born with the condition and died. When HIV tests became available, the prospect of one was terrifying, involving a week-long wait for results and a recommendation to take a friend when results were due to be delivered. 

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Unravelling the mystery of smaller lungs in low- and middle-income countries

Andre Amaral

In low- and middle-income countries (LMICs), a notable number of individuals have smaller lungs for their sex, age, and height, especially in South and East Asia, as well as sub-Saharan Africa. The key question: Why does this pattern persist in these regions?

This phenomenon extends beyond physiological concerns, and as indicated by recent studies, reveals a troubling link between smaller lungs and heightened risks of suffering from heart disease and diabetes. Dr André Amaral, an epidemiologist at the National Heart and Lung Institute (NHLI), explores this phenomenon.


The BOLD study

Chronic lung diseases affect millions of people of all ages worldwide. Approximately 20 years ago, the Burden of Obstructive Lung Disease (BOLD) study was set up by Imperial College London to find out more about the prevalence and determinants of chronic obstructive pulmonary disease (COPD), which back then, was already considered a leading cause of disability and death.

The BOLD study was conducted in 41 sites across Africa, Asia, Australia, Europe, the Caribbean and North America, and recruited more than 30,000 adults aged 40 years and over. The large coverage of world regions, and ethnic groups, as well as the large number of participants, all answering the same questions and undergoing the same measurements in a standardised manner, makes the BOLD study unique. Participants in this study provided information on several characteristics of their life. This included whether they had been diagnosed with lung disease, a heart disease, or diabetes, whether they smoke or ever smoked, their weight and height, and their highest level of education. The level of their lung function was measured through a medical test called spirometry, which measures how much air a person can breathe out in one forced breath.

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Nurturing hope: Understanding Dilated Cardiomyopathy and transforming heart failure prospects

As the leading cause of heart failure in young individuals, dilated cardiomyopathy presents a unique set of challenges and implications. It is an intrinsic heart muscle disease that is the most common reason for needing a heart transplant. The origins of this condition are diverse, spanning genetic predispositions, external triggers that subject the heart to undue stress, or often, a combination of both. Dr Brian Halliday, a Clinical Senior Lecturer and British Heart Foundation Intermediate Fellow at the National Heart and Lung Institute sheds light on this disease and how medical advancements have enabled some patients to go into remission.


Heart failure can be a devastating diagnosis. The prognosis has been shown to be worse than many of the most common cancers. The words themselves often create a sense of doom for patients.

Dilated cardiomyopathy is the most common cause of heart failure in young people and the most common reason to need a heart transplant. It is an intrinsic heart muscle problem where the heart becomes baggy and weak. It may be due to genetic susceptibility, extrinsic acquired triggers that put the heart under stress, or a combination of the two. At the National Heart and Lung Institute, we have a particular interest in dilated cardiomyopathy.

The heart of a patient with dilated cardiomyopathy
The same patient’s heart after undergoing remission

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Getting to the Heart of the Matter: Sex Differences in Cardiomyopathy

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Could variation in the architecture of men and women’s hearts explain why their risk of cardiomyopathy differs? Dr Paz Tayal, Clinical Senior Lecturer in Cardiology at the National Heart and Lung Institute is investigating this with the aim of improving outcomes for patients affected by this disease of the heart muscle. Dr Tayal also discusses the ‘juggle struggle’ of balancing work and family life, and the importance of truth telling in academic medicine.


As winter sets in, I start to pack away the summer dresses and bring out the woolly jumpers and sturdy boots. When I do this, I will not be going into my husband’s closet to find things that fit me, nor indeed will I be wearing his shoes.

That seems obvious right, because we are different sizes.

We don’t think twice about that, yet in medicine, we are only just beginning to realise that male and female patients might need to have tailored ways to diagnose and treat disease.

Even in health, male and female hearts are not the same. At birth, the hearts of male and female babies are about the same size. However, at puberty, male hearts have a faster period of growth compared to female hearts. Whilst this eventually settles down, throughout adult life the mismatch persists, and the female heart remains smaller.

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Tackling syncope – a significant diagnostic challenge for many

Syncope–a transient loss of consciousness–occurs in 42% of people by the age of 70. Professor Richard Sutton, Emeritus Professor of Clinical Cardiology, discusses this common medical problem, and how he has pioneered a “true but still insufficiently small interest” in it.


I have been Emeritus Professor of Clinical Cardiology at Imperial since 2011. Prior to that, I had trained in Cardiology at St George’s Hospital, the University of North Carolina, and the National Heart Hospital in London, becoming Consultant Cardiologist at Westminster Hospital in 1976. There I focused on cardiac pacing as a subspecialty. From a clinical perspective, cardiac pacing eradicated syncope (transient loss of consciousness) in patients with conduction tissue disease of the heart. So, I sought to extend the role of pacing into related syncope conditions.

My primary interest therefore became the symptom of syncope. I began this in the late 1970s, and formed a close relationship with Worthing Hospital which carried a heavy load of older patients, many of whom presented syncope. I founded an outreach clinic at Worthing which led to the receipt of many challenging patients with syncope in whom there was no obvious cause.

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Margaret Turner Warwick Centre: Can we take your breath away?

The Great Exhibition Road Festival is a free annual celebration of science and the arts each summer in South Kensington. The event showcases a diverse range of activities for people of all ages.  One of those activities, led by researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis, included an interactive activity that gave the public the opportunity to walk in the shoes of someone living with pulmonary fibrosis. Find out first-hand from Elisabeth Pyman, what happened on the day and hear from pulomary fibrosis patient, Andy, what it’s like to live with the condition.


The June weekend of the Great Exhibition Road Festival was one of quintessential British summertime weather. This celebration of science was hosted by Imperial College London in collaboration with the local community and provided a wide range of topics for people of all ages to explore. Under intermittent spells of rain, crowds of a multitudinous diversity explored the “awe and wonder” of science, the theme of this year’s festival. To welcome the public, artists and scientists populated the streets and buildings surrounding Imperial’s South Kensington campus like a sudden desert bloom.

Meanwhile, another transformation was taking place in a stand tucked away at the end of the road in the Creative Science zone. Researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis were on a mission to spread awareness about a rare lung condition known as pulmonary fibrosis. This condition is associated with a build-up of scar tissue that leads to a steady decline in lung function, with many patients becoming terminal only five years after diagnosis. Currently, there are 32,500 UK residents living with a diagnosis, but the actual number of people affected is estimated at around 100,000.

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HIV antiretroviral therapy: Getting to the heart of the matter

The HIV landscape has completely transformed since the start of the pandemic. A HIV diagnosis in the 1980s was considered fatal, as people usually progressed to AIDS due to the lack of available treatments. 42 years later, we have an array of different drug options and as a result, people diagnosed with HIV today can now expect to have near-normal life expectancies. Here, Dr Akif Khawaja from the National Heart & Lung Institute (NHLI), highlights the impact of HIV treatment over the last 42 years and how it influences cardiovascular research today.


HIV Treatment: from AZT to U=U

At the start of the pandemic, there were no available treatments. Patients would progress to AIDS and were only offered palliative care. It wasn’t until 1987 that the first antiretroviral drug, zidovudine (AZT), was licenced for the treatment of HIV. A major challenge with HIV treatment soon became apparent, as the virus can rapidly mutate and change its genetic code to become resistant to the drug supressing its replication. This challenge was quickly seen by clinicians as their patients would start to rebound from antiretroviral monotherapy (one drug regimens) as HIV became drug resistant and was able to replicate again. The introduction of combination antiretroviral therapy in 1996 has been monumental to HIV management. A change in treatment guidelines meant that patients who would have previously been given one drug, were now given three drug combinations, each targeting different parts of the HIV life cycle. This approach meant that patients could suppress HIV replication and achieve a sustained undetectable viral load, meaning that the level of virus in their blood is so low, it can no longer be detected by diagnostic tests.

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Professor Sir Peter Barnes knighted for excellence: Reflections on his career in respiratory science

Professor Sir Peter Barnes FRS FMedSci, from the National Heart and Lung Institute (NHLI), was made a Knight Bachelor in this year’s King’s Birthday Honours “for services to respiratory science.” Sir Peter is Professor of Thoracic Medicine at the NHLI and he was Head of Respiratory Medicine at Imperial until 2017. Here he writes about his reaction to his award and describes some of the current research projects in chronic obstructive pulmonary disease (COPD).


A surprise! 

My wife opened the letter “On His Majesty’s Service” as she thought it was a tax demand – I was absolutely shocked to see I had been offered a knighthood. Of course, I was and am delighted with the award. It is very good for respiratory science and medicine, which generally receives little public attention. This is surprising as chronic lung diseases are amongst the most common in the UK, affecting one in seven people and the third ranked cause of death. I would like to dedicate this award to all the brilliant students, post-docs, research fellows, visiting scientists and colleagues that I have worked with at Imperial College London over many decades.  

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Making Waves at the National Heart and Lung Institute

Helen Johnson, Communications and Marketing Manager at the National Heart and Lung Institute (NHLI) discusses her recent project ‘Making Waves, which set out to update the Department’s imagery across their buildings to better reflect the diversity of NHLI’s community and inspire the next generation.


“Sometimes our stories make us stronger”

This is what one of our contributors said to me during her interview, and I couldn’t have summed up Making Waves any better. This project set out to showcase the people behind the great science and teaching that the NHLI is known for. 

We don’t always think about it on a daily basis but when you actually look at who is celebrated in the imagery on our walls, it tends to be people who no longer work for the Department, and they tend to also share characteristics in terms of their age and race. But, then again, it is just a portrait of that person, so we don’t necessarily know their whole story by just looking at an image. Everyone has their own story. 

The founding premise of ‘Making Waves’ was that anyone should be able to look at these new portraits and see themselves. So that everyone can know they are welcome at NHLI  and in science – that they belong. I was tasked with this vision by my Head of Department, Professor Edwin Chilvers, who was keen we brought our imagery more up to date to represent who NHLI is today. The leaky pipeline in science for those holding protected characteristics has been much reported, and is easy to see when you look for instance at the number of Black Professors across not just NHLI, but across the whole of Imperial. One set of portraits will not solve this, but hopefully by showing a greater variety of successful people and their journeys, others will be inspired to continue their own scientific paths.

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Inspirational leadership matters: supporting the next generation of clinical academics

Dr Maddalena Ardissino

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.


The journey to becoming a clinical academic can be long and arduous, with many obstacles. Dr Maddalena Ardissino, from the National Heart and Lung Institute, reflects on her own experiences as a trainee and explains why mentorship is key to supporting the growth and development of young, aspiring clinical academics.

Almost exactly five years ago, I stood amongst a crowd of young academics at a poster session at the Intensive Care Society’s annual conference, experiencing a feeling of anxiety I’ve never known before or since. I was in my fifth year of medical school and standing in front of a group of excellent researchers who were about to listen to me give my first scientific presentation. It seemed unthinkable to me, at the time, to think that they might have the slightest interest in what I had to say.

Since then, my journey through clinical and academic training has been what I can only describe as an adventure. I quickly realised that there isn’t a single defined path for clinical academics, with each individual moulding a slightly different journey. When I look around at my fellow clinical academics at the National Heart and Lung Institute, however, there is one key feature that we all share: enthusiasm. And behind this feature there is one single, common theme: the support of a truly inspirational mentor.

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