Todd T. Brown, MD, PhD
Dr. Brown, Associate Professor, has been working in the area of metabolic complications in HIV-infected persons for over ten years.
His research seeks to understand the epidemiology, causes and consequences of the diverse, yet related endocrine problems such as diabetes, dyslipidemia, hypogonadism, fat redistribution, and osteoporosis. Dr.
Brown plans to investigate bone density, bone strength and bone quality in ALIVE and the contributions of opiate use, body composition (such as lean body mass), and HCV and HIV.
David Celentano, ScD, MHS
Dr. Celentano is Professor and Chair of the Department of Epidemiology at JHBSPH. He has extensive experience in the study of health behavior and barriers to behavior change in injection drug users, men who have sex with men, and sex workers.
He has completed multiple epidemiologic studies of risk behavior related to HIV infection and STIs in ALIVE since its inception, and has conducted multiple phase III prevention trials of behavioral interventions to prevent HIV transmission.
He has also been instrumental in characterizing the natural history of drug abuse in this cohort.
Derek Cummings, PhD, MPH, MSc
Dr. Cummings is an Assistant Professor in the Department of Epidemiology of JHBSPH with a joint appointment in the Department of International Health. Dr.
Cummings' research is focused on understanding the temporal and spatial dynamics of the spread of infectious diseases in order to inform interventions to control their spread. He has worked extensively in the areas of influenza, dengue, chikungunya and measles in multiple settings including India and China.
His research within ALIVE is to develop mathematical models that can assess multiple strategies of intervention to reduce infection, morbidity and mortality from Hepatitis C infection in injection drug users.
Michael Bradley Drummond, MD, MHS
Dr. Drummond, Assistant Professor of Pulmonary and Critical Care Medicine, is a clinical and translational researcher whose research focus includes characterizing the mechanisms for development of chronic lung disease in HIV-infected individuals.
His primary project is an NHLBI-funded study of the pulmonary compartment of smokers at risk for or with COPD and HIV through performance of bronchoscopic alveolar lavage sampling as well as airway brushings. Additionally, Dr.
Drummond has been involved in characterizing the longitudinal impact of smoking, HIV infection and tobacco dependence on long-term outcomes related to chronic obstructive pulmonary disease in the ALIVE cohort.
Homayoon Farzadegan, PhD
Dr. Farzadegan, Professor, is a viral epidemiologist in the Infectious Diseases Program. He has been the director of Central Lab and Core Repositories (CLCR) since 1985 and has been actively involved in many case/control and cohort studies.
He has extensive experience in laboratory methods for detection and quantitation of human viral infections as well as host responses. He has been actively participating in ALIVE study since the start of the study in 1988.
His research focuses on the genetic, immunologic, virologic and serologic factors related to HIV/AIDS and he has published extensively on these viral-related aspects of HIV infection.
Noya Galai, PhD
Galai, an Associate Professor at JHBSPH, is a biostatistician with extensive experience in the statistical analysis of HIV cohort studies, having been involved with the ALIVE study since 1991.
She has particular expertise in complex longitudinal analyses to characterize trajectories of drug abuse, health care utilization and other outcomes using the 25 years of data that has been collected in ALIVE.
Stephen Gange, PhD
Dr. Gange is a Professor and Deputy Chair of the Department of Epidemiology at JHBSPH. Dr.
Gange was recruited to the STATEPI (Statistics in Epidemiology) group in 1994, and has since been a co-investigator of the Center for the Analysis and Management of the Multicenter AIDS Cohort Study. In 1997, Dr.
Gange was pivotal in obtaining the Women’s Interagency HIV Study (WIHS) Data Management and Analysis Center (WDMAC) and has served as Principal Investigator of this study beginning in 2001.
He played a key role in the establishment of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) as part of a global International Databases to Evaluate AIDS program to establish a collaborative group of international regional data centers whose purpose is the compilation of HIV/AIDS data to address research questions in HIV/AIDS that are not possible to answer with currently existing individual cohorts.
Bryan Lau, PhD, MHS
Lau Lau is an Assistant Professor, and his research interests include development and application of epidemiologic and statistical methods for HIV research including application to the evaluation of therapies, investigation of biomarkers, and the etiology of HIV/AIDS disease progression.
A recent area of specific statistical methodological development includes the development and application of competing risk approaches. Epidemiologic methods include investigation of the differences between interval and clinical cohort studies.
Gregory M. Lucas, MD, PhD
Lucas, Associate Professor in the School of Medicine’s Infectious Diseases Department, focuses on improving clinical outcomes in HIV-infected injection drug users (IDUs).
He has received funding from HRSA and NIDA to evaluate the efficacy of integrated buprenorphine treatment for opioid addiction in an HIV clinic, compare directly-administered to self-administered antiretroviral therapy for HIV-infected patients in methadone clinics, and to assess the efficacy of integrated HIV testing and treatment clinics for IDUs in India. He is actively involved in protocols that address the intersection of IDU and HIV with the HIV Prevention Trials Network (HPTN) and NIDA’s Clinical Trials Network (CTN).
Joseph B. Margolick, MD, PhD
Dr. Margolick, Professor of Molecular Microbiology & Immunology, established the Flow Cytometry and Cell Sorting Core Laboratory in the Johns Hopkins School of Public Health in 1986 and has served as director of this facility since then.
He was a co-investigator on the original ALIVE grant application in 1988 and has been responsible for the measurement of T cell subsets for the ALIVE study since it began. The Core Laboratory has been sorting HIV-infected specimens at BSL3 since 1989. Dr.
Margolick has also worked on quality control and cohort study applications of immunophenotyping and flow cytometry.
Richard D. Moore, MD, MHSc
Dr. Moore, Professor of Internal Medicine, has been an HIV clinician and has conducted HIV-associated clinical and outcomes research at Johns Hopkins since 1988, having now published over 250 papers on HIV natural history, treatment and outcomes. Dr.
Moore is the director of the Johns Hopkins HIV Clinical Cohort, which has the aims of understanding treatment and outcomes in HIV-infected patients.
He is the Principal Investigator of the North American AIDS Cohort Collaboration on Research and Design and the HIV Research Network, two large multisite cohorts spanning North America.
Kenrad E. Nelson, MD
Dr. Nelson, a Professor in Epidemiology and Medicine, has extensive experience in epidemiologic studies and clinical trials of infectious diseases. Dr.
Nelson was the PI of the ALIVE II study for a decade from early in the study through the late 1990’s.
He has remained actively involved in all aspects of the study since that time, providing input on study design, data collection, and leading multiple analyses, primarily of HIV incidence, bacterial and viral co-infections, sexually transmitted diseases, and other clinical complications of HIV infection. Dr. Nelson has led numerous sub-studies (Staphylococcal aureus nasal carriage prevalence and risk factors) and clinical trials (trials of 2 different pneumocccal vaccines) nested within ALIVE.
Elizabeth Stuart, ScD
Dr. Stuart is an Assistant Professor in the Department of Mental Health with a joint appointment in Biostatistics.
Her research focuses on the development of statistical methods for estimating causal effects, and the application of those methods to mental health, education, and public policy.
She has expertise in the use of propensity score methods to estimate causal effects in non-experimental studies and has been working to develop methods to assess the generalizability of results from randomized trials to target populations.
She will adapt these methods to adjust the multiple recruitment waves within ALIVE to be similar to one another with respect to the observed characteristics to allow for more appropriate comparisons of trends over time.
David Thomas, MD, MPH
Dr. Thomas is a Professor of Medicine and Epidemiology and the Chief of the Infectious Disease Division of the Johns Hopkins University School of Medicine.
He also directs the Viral Hepatitis Laboratory and co-directs the Johns Hopkins Liver Center. Dr. Thomas has extensive experience with epidemiologic and virologic studies of viral hepatitis including studies of hepatitis C among injection drug users in Baltimore, MD. Dr.
Thomas has been an active investigator in this cohort for more than 10 years.
Ryan P. Westergaard, MD, PhD
Dr. Westergaard is an early-stage investigator with clinical expertise in the treatment of HIV-infected individuals with substance use and psychiatric disorders.
During his post-doctoral clinical research training program in infectious diseases at Johns Hopkins, he joined the team of collaborators for the ALIVE study and worked on a pilot study of an mHealth intervention to improve engagement in HIV care among IDUs. Dr.
Westergaard’s research focuses on barriers to optimal effectiveness of antiretroviral therapy for IDUs, and he will play a prominent role in designing studies that utilize data collected through ALIVE to identify modifiable risk factors for poor engagement in HIV care and antiretroviral treatment failure.
Johns Hopkins Gazette | December 8, 2003
Although more American adults than children are infected with the HIV virus, children with the disease use more HIV-related health care services, a Johns Hopkins Children's Center researcher reports.
“Because infants and toddlers are more ly to visit their pediatrician on a regular basis, and because physicians believe that administering highly active antiretroviral therapy to babies and infants early on helps establish and maintain levels of viral suppression, we weren't really surprised by these results,” said the study's lead author, George Siberry, a pediatrician at the Children's Center.
“However, our study — believed to be one of the first to examine health care utilization patterns of HIV-infected children since the widespread use of HAART — also suggest that the demand for care for HIV-positive children means we need to look carefully at how we are delivering it and what more we can do to improve access and services,” he added.
In their report, presented Nov.
3 at the American Academy of Pediatrics 2003 National Conference and Exhibition in New Orleans, investigators at Johns Hopkins and five other institutions from the HIV Research Network report that HIV-positive children — particularly those under 2 years of age — make a high number of outpatient visits and are frequently hospitalized. Furthermore, 90 percent of all HIV-infected children receive antiretroviral medications.
According to the U.S. Centers for Disease Control and Prevention, by the year 2001 there were more than 170,000 adults and adolescents and approximately 4,000 children in the United States infected with the HIV virus (these statistics may not include data from all 50 states).
“An understanding of how real HIV patients access the health care system, and what services they do or do not utilize, provides policy-makers, medical providers and HIV program managers with the knowledge to make important decisions on HIV care that reflects what is really happening out there in the HIV community,” Siberry said.
In the current study, Siberry and colleagues examined the clinical records of 364 HIV-infected children seen in 2000 at five pediatric sites of the HIV Research Network. The children, mostly female and African-American, were all infected by transmission of the virus from their infected mother during pregnancy or delivery.
In particular, researchers focused on the number of inpatient and outpatient visits, in addition to how many children were prescribed ART.
They found that HIV-infected children had an average of eight yearly outpatient visits and a one-in-three chance of requiring inpatient admission in the year 2000.
HIV-infected children under 2 years of age had more than nine outpatient visits per year and a two-in-three chance of being admitted during that year.
Compared to healthy children in the United States, HIV-infected children are hospitalized 10 times more often and have three times as many yearly outpatient visits. Although hospitalization rates for children with HIV were slightly lower than that of HIV-infected adults, the children had 30 percent more outpatient visits.
In addition to younger children, children with more advanced HIV infection, high viral loads or AIDS, or those of non-Caucasian ethnicity, had significantly more outpatient visits and hospitalizations in 2000.
“The good news from these findings is that hospitalization rates and outpatient visits for HIV-infected children appear to be three to four times lower than they were for HIV-infected children in the early 1990s when HAART therapy was not available,” Siberry said.
The HIV Research Network comprises 18 medical institutions located across the United States that treat more than 16,000 patients with HIV disease.
Each institution assembles data on the clinical and demographic characteristics of its HIV-infected patients, the frequency of each patient's outpatient clinic visits and the number of inpatient admissions.
Participating institutions then send the information to the data coordinating center located at the Johns Hopkins School of Medicine, where the information is consolidated into a single uniform database.
Co-authors of this study are Kelly Gebo of the Johns Hopkins School of Medicine; Richard Rutstein of Children's Hospital of Philadelphia; Patricia Flynn of St. Jude's Children's Hospital; and Stephen Spector of the University of California, San Diego.
Johns Hopkins to Perform First H.I.V.-Positive Organ Transplants in U.S
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Johns Hopkins said it was set to perform the first kidney and liver transplants between H.I.V.-positive donors and H.I.V.-positive patients in the United States, a development that advocates said could create a lifesaving pipeline for H.I.V. patients while shortening organ donor waiting lists for all.
Dr. Dorry Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine, estimated that organs from 500 to 600 H.I.V.-positive potential donors have gone to waste each year and that allowing those donations could save more than 1,000 people.
“That’d be the greatest increase in organ transplantation that we’ve seen in the past decade,” he said in an interview Tuesday.
Since 1988 until November 2013, when President Obama signed the H.I.V. Organ Policy Equity Act into law, medical facilities had been forbidden from such transplants.
After receiving approval in January from the United Network for Organ Sharing, which manages the nation’s organ transplant system, Johns Hopkins was prepared to perform a transplant as soon as a suitable organ and recipient emerged, the hospital said.
H.I.V.-positive patients can receive organs from donors without H.I.V., so the addition of the new organs could also bump those without H.I.V. up the waiting list. About 122,000 people in the United States are on the list, Johns Hopkins said.
Patients without H.I.V. would not receive organs from H.I.V.-positive donors.
Giving H.I.V.-positive patients donated organs was once considered unnecessary.
The 2013 HOPE Act reversed a transplant ban that was passed in 1988 — a time when AIDS fears were high — as part of an amendment to the National Organ Transplant Act. Dr.
David Klassen, the chief medical officer for the United Network for Organ Sharing, said the medical outlook for H.I.V. patients had drastically changed since then.
“Nobody would consider transplanting an H.I.V.-positive recipient because everyone knew their life span was short,” Dr. Klassen said. He added that “the notion that H.I.V.-positive recipients could be transplanted arose as a result of their extended life spans.”
Because H.I.V.-positive organ transplants have never been done in the United States, medical facilities do not have systems in place to handle them, Dr. Segev said. He anticipated a trickle of transplants at first until those systems are established, with the rate slowly ticking upward.
At least initially, the focus will be on deceased donors, Dr. Segev said. More studies are required to ensure it is safe for an H.I.V.-positive patient to donate a kidney, he said.
Aside from the medical potential, the ability to become an organ donor upon death is welcome news among H.I.V.-positive patients, Dr. Segev said.
“People want to leave a living legacy; they want to help,” he said. “And to be stigmatized and told, ‘You can’t help because you’re H.I.V.-positive’ can be devastating. This removes yet another stigma associated with H.I.V.”
Michael Kaplan, president of the AIDS United lobbying group, has lived with AIDS since 1992 and Type 1 diabetes since 1980. He said in an interview that H.I.V.-positive patients would appreciate having more medical options — and that he suddenly realized he would have to update his own donor information.
“The idea that my organs could now benefit someone living with H.I.V.? Heck yeah,” he said.
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