Researchers Identify Timeline for HIV Replication in the Brain

Ron Swanstrom, PhD

Ron Swanstrom, PhD

A team of researchers has discovered HIV can begin replicating in the brain as early as four months after initial infection. The study followed 72 treatment naïve participants during the first two years of HIV infection. Through analysis of cerebral spinal fluid (CSF) and blood samples, 20 percent of subjects showed replication in the central nervous system (CNS) at four months. Additionally, 30 percent of participants showed evidence of a marked CSF inflammatory response in at least one time point and 16 percent of study volunteers showed a marked CSF inflammatory response at multiple time points, suggesting an ongoing infection in the CNS. The findings will be published in the scientific journal PLoS Pathogens.

“This shows that viral replication and inflammation can occur early in infection with the concern being that the damage caused could be irreversible,” says study virologist Ronald Swanstrom, PhD, Director of the University of North Carolina’s Center for AIDS Research (CFAR) and Professor of Biochemistry and Biophysics at UNC’s School of Medicine. “HIV and inflammation have the potential to accelerate the aging process and cause neurocognitive impairment, in the extreme case resulting in HIV-associated dementia.”

One-third of people not taking antiretroviral therapy (ART) to control their HIV will eventually develop HIV-associated dementia, Swanstrom says. For him, the study’s results in these newly infected people stress the importance of routine HIV testing to catch the infection as early as possible to allow the prompt initiation antiretroviral therapy.

“This is yet another reason we want people on ART right away to limit the possibility of replication and inflammation in the brain,” Swanstrom says.

Future studies could focus on whether or not damage to the brain caused by this early replication and inflammation is reversible. Swanstrom collaborated on the study with senior author and neurologist Serena Spudich, MD, Division Chief of Neurological Infections & Global Neurology and Associate Professor of Neurology at Yale School of Medicine, and neurologist Richard Price, MD, Professor of Neurology at the University of California San Francisco School of Medicine. The first author on the study was a UNC graduate student in the Department of Microbiology and Immunology, Christa Sturdevant, who is now a postdoctoral fellow at Duke University. The study was funded by the National Institute of Mental Health.

Pharmacy Students Gain Global Training

MalawiPharmacy1WEBUNC pharmacy student Michael Chargualaf learned firsthand why Malawi is known as the “Warm Heart of Africa.” In June 2014, he traveled there along with fellow pharmacy student Jordan McNair, and instructors Amanda Corbett, PharmD, and Daniel Forrister, PharmD. The trip exposed Chargualaf to pharmacy practices in a developing country.

“The overall experience in Malawi was extremely humbling and enlightening,” Chargualaf says. “The Malawian people that we met along the way were very kind-hearted and welcoming.”

This inaugural trip was a pilot to prepare for an ambitious program being launched by the UNC Eshelman School of Pharmacy, called the Global Pharmacy Scholars (GPS) Program, in an effort to expand global experiential training for pharmacy students. The School of Pharmacy’s Global Engagement Fellow David Steeb, Pharm D, spearheaded development of the program. Corbett says six students will travel to Malawi this summer, two each month from June to August.

“The goal is to give UNC pharmacy students a global, experiential education,” Corbett says. “We also identified four sites in Malawi where we could offer our assistance long-term and we will continue our work with these partners.”

MalawiPharmacy2WEBRelationships established with UNC Project Malawi leaders over many years include Mike Cohen, MD; Irving Hoffman, PA, MPH; Mina Hosseinipour, MD, MPH; and Francis Martinson, MD, PhD, as well as relationships developed this past year including Innocent Mofolo, MSc; Dorothy Sichali, Wilberforce Mhango, and many, many others. In addition, UNC works with many partners in Lilongwe, Malawi, including Kamuzu Central Hospital, Lighthouse Trust, Bwaila Hospital and the District Health Center. Many individuals from these programs were instrumental in making the pilot project a success, including Tadala Hamisi, Sam Phiri, MSc, PhD; Colin Speight, MBChB; and Rose Chikumbe.

During last summer’s pilot of the program, the team visited the District Health Center’s medication dispensary in Lilongwe. Corbett says the office faces challenges including a broken printer and no cooling system to control the temperature of medications.

“The people working at the district office were incredibly warm and helpful,” Corbett says. “They wanted to do the right thing, but they lack the resources.”

MalawiPharmacyBeachWEBThe pharmacy team also had the opportunity to visit the University of Malawi College of Medicine Pharmacy Department in Blantyre and establish connections with Department Chair Nettie Dzabala and Professor Lutz Heide among other faculty members. The team learned a lot about each of the respective pharmacy programs and agreed to continue collaborations in the future.

“I had an amazing experience in Malawi. I learned so many new things about the country, the people, and their health care system. It reaffirmed my career interests in public health, but really elucidated the opportunities in infectious disease as well,” says McNair. “A powerful and sustainable pharmacy influence is greatly needed in Malawi. Medication experts who can provide guidance on research and drug regimens and who can be accessible to the thousands of people who get lost in the system would be of great public health benefit as well as financial benefit to the country.”

Also while in Malawi last year, the UNC pharmacists and pharmacy students gave two lectures on conditions commonly treated in Malawi – HIV and cancer. Corbett presented on antiretroviral therapy, discussing side effects and proper dosing. Chargualaf focused on cancer treatment. He and Corbett also joined physicians on rounds at the Kamuzu Central Hospital (KCH). Unlike hospitals in the United States where a variety of medications for each condition are readily available, Corbett says KCH clinicians need to check each day what drugs are available in the hospital pharmacy before ordering medications for their patients.

MalawiPharmacySunsetWEB“The breadth of available medications is limited,” Corbett says. “For example, they do not have five choices of drugs to treat high blood pressure like we do here.”

Still, Chargualaf was able to roll up his sleeves and help. He mixed chemotherapy drugs with KCH pharmacists.

“I strongly believe that it is important to all future pharmacists to be culturally competent and have the ability to connect and assist people from diverse backgrounds, even if they chose not to become involved with global health in their ultimate career,” Chargualaf says. “I believe pharmacists can impact and influence patient lives in more ways than medication safety and management. To do this, we all need to be culturally competent.”

Video: ID Combines Passion for Research, Clinical Care

Alex Duncan, MD, PhD

Alex Duncan, MD, PhD

Alex Duncan, MD, PhD, knew he wanted to pursue a career as a physician scientist, but infectious diseases wasn’t always on his radar. A clinical rotation under the guidance of an infectious diseases attending physician during his third year of medical school changed all of that.

“I went down the infectious diseases rabbit hole,” Duncan says with a laugh. “Infectious diseases captured a way for me to do research and stay in medicine at the same time.”

Duncan wears many hats at UNC: He sees patients at UNC’s Infectious Diseases Clinic at NC Memorial Hospital; He conducts research in his lab with a focus on innate immune signaling or how the body recognizes and responds to pathogens; He is an Associate Professor of Medicine and Pharmacology at UNC’s School of Medicine; and Duncan recently accepted the role as Director of UNC’s Infectious Diseases Fellowship program.

Click here to watch a video of Duncan.

As a clinician, he says he applies the same conceptual process he uses to conduct research in his lab to treating a patient in the clinic. For example, if Duncan sees a patient suffering from a fever of unknown origin, a common reason that he and other infectious diseases physicians are consulted, he gathers preliminary information by examining the patient’s medical records as well as taking detailed note of their travel and exposure history. This information guides formulation of his hypothesis on the origin of the patient’s illness. He then orders tests and based on these results, he either verifies the diagnosis or revises his hypothesis.

“You can take a scientific experimental approach to each patient,” Duncan says. “In this way, practicing infectious diseases is intellectually compatible with performing translational research.”

Research has always been his passion. Duncan is especially interested in the body’s inflammatory response to pathogens like bacteria.

“In my heart of hearts, I am a hardcore bench translational researcher,” Duncan says. “I love going into my lab and seeing new data. That new answer to a question no one has seen before. That discovery that drives patient care down the line. UNC provides a great environment for our trainees to develop careers as physician scientists.”

And it’s the career development component that Duncan really wants the ID Fellowship experience at UNC to stress. The three-year program provides fellows with a mix of clinical and research training. But Duncan says under his direction, he wants the program to also provide mentoring, networking and cultivation of other necessary skills for this career path, such as grant writing.

“I recognized early on in my career as an MD-PhD that to be successful in research took a lot more than me just knowing how to do research or being a decent clinician,” Duncan says. “I really relied on the help of a lot of people, networking and developing skills outside of things that we normally think of physicians receiving traditional training in. Career development is very important. We can help with all of these. We limit the number of fellows we take. We give them a lot of personal attention. That’s been the hallmark of our program.”

For more information about UNC’s Infectious Diseases Fellowship, click here. For information about Duncan, click here.

State’s Largest Clinical HIV Conference Set for May 4 and 5

HIV-RibbonWEBAt least once a week, Christopher Hurt, MD, Clinical Assistant Professor at the University of North Carolina’s School of Medicine, receives an email from a physician or other health care professional seeking advice about treating a patient living with HIV infection. “Clearly, there are providers out there who are caring for people living with HIV infection and are looking for more education,” says Hurt.

In response, UNC’s School of Medicine, Eshelman School of Pharmacy, and Center for AIDS Research (CFAR), along with the Greensboro Area Health Education Center (AHEC) and the NC AIDS Training and Education Center (NCATEC) have organized an annual training each May. It is the largest statewide HIV conference offered in North Carolina. The two-day training will feature tracks dedicated to arming clinicians, allied health professionals, dentists and pharmacists with the latest HIV, hepatitis C virus (HCV) and other sexual transmitted infection news.

“Even if you only have one patient with HIV or HCV, you should attend,” adds Hurt. “PrEP (pre-exposure prophylaxis) is one of the recent developments in HIV care that I get a lot of calls about – there’s just been a lot of new treatment information for HIV and HCV in just the last couple of years. We have experts in the field who will get you up to speed so that you can provide your patients with better care.”

In its 20th year, the conference is called Clinical Care in 2015: HIV, Hepatitis C and Vulnerable Populations. It will be held Monday and Tuesday, May 4 and 5.

“The conference includes a track for non-prescribers who are still very important team members in taking care of these patients,” says Heidi Swygard, MD, MPH, who has been organizing the event for the past six years. “The vulnerable populations track for non-prescribers is intended to highlight a specific population and heighten cultural competency.”

For the second year in a row, day two of the conference will feature presentations specifically tailored to dentists and pharmacists. The conference planning committee creates the agenda with participant feedback in mind, says David Wohl, MD, Associate Professor of Medicine at UNC and Director of the NC AIDS Training and Education Center, a conference sponsor.

“We listen to the evaluations we solicit at the end of each year’s conference,” Wohl says. “We are guided by participant input. We want this conference to be worth people’s time and to get even better every year.”

More than 28,000 people in North Carolina were living with HIV at the beginning of 2014, according to the NC Department of Health and Human Services. Hurt opens the conference with a presentation called HIV in America, which he says will give participants an overview of the epidemiology of HIV with an eye toward new information.

“Young, African American men who have sex with men continue to have the highest incidence of new infection and that’s not because they are engaging in any riskier behavior,” Hurt says. “So a portion of my talk will discuss why this is happening.”

One of the phone calls Hurt received recently was from a physician who had started a patient on pre-exposure prophylaxis or PrEP to prevent HIV. Although the Food and Drug Administration (FDA) approved PrEP in 2012, it has not been widely prescribed.

“I’ve noticed in the past six months a growing interest for PrEP in the community and that is driving physician interest,” says Hurt.

The conference will feature a PrEP panel. Local people taking PrEP daily to prevent HIV infection will share their experiences. Adam Ward, a graduate student at NC State University is one of the panelists. He started taking PrEP daily this fall after learning his partner had been unfaithful.

“It gives me peace of mind and reduces my risk of getting HIV,” Ward says.

Click here for a list of PrEP providers in North Carolina.

HCV is another popular topic that will be discussed as it relates to treating patients who are mono-infected or co-infected with HCV and HIV.

“We are light years ahead of where we were five to 10 years ago, when people took twice-daily pills along with a weekly shot for 48 weeks. They experienced horrible side effects,” Hurt says. “Now we have oral treatment for a maximum of 24 weeks that is much better tolerated. This is a rapidly evolving field and there is a big wave of patients coming to us seeking treatment.”

The second day will focus on the latest HIV news as it relates to pharmacists and dentists. Amanda Corbett, PharmD, Clinical Associate Professor at UNC’s Eshelman School of Pharmacy, is one of the day’s presenters.

“It is always rewarding to meet with colleagues and share ideas and experiences in caring for HIV patients,” Corbett says. “The complexities of medication management with antiretrovirals are ever changing and critical for pharmacists to play a significant role. Last year was the inaugural pharmacy focused session on day two of the conference. It was a great success for which we hope to build upon for 2015!”

To register for the conference, visit http://www.aheconnect.com/ncahec/findevents.aspx?a=5

Watch: Dr. Mike Cohen Encourages HIV Transmission Workshop Attendance

Watch: David Margolis Shares Latest HIV Cure News from CROI

Student International Travel Requirements

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UNC School of Medicine AIDS Training Ranks 6th in the Nation

Introduction to Malawi: A Workshop on Chichewa Language and Malawi Culture

MalawiWorkshopWhen: Thursdays – March 26, April 2, April 9  & April 16 from 5:30-7:30 p.m.
Location: UNC Eshelman School of Pharmacy, Beard Hall, Room 102

This four-part workshop will focus on introductory Chichewa greetings and linguistics, medical interview vocabulary, and cultural sensitivity in health services for UNC students, staff and faculty planning research, service or internships in Malawi.  Workshop sessions cover elementary language construction, health and cultural training, as well as brief presentations on the history, geography, politics and economy of Malawi.  Participants will be provided soft copies of readings and basic language material. Dinner will be provided. Attendance at a minimum of 3 sessions is required.

Space is limited – please register by emailing Mamie Harris at malawi@unc.edu . Also contact Mamie for additional questions or concerns.

This workshop is sponsored by the UNC Institute for Global Health & Infectious Diseases (http://globalhealth.unc.edu/) and the UNC African Studies Center (http://africa.unc.edu/index.asp)

Watch Video: David Margolis Talks HIV Cure, Med Adherence and New Strain