News Highlights
Opinion: World AIDS Day is about how far we’ve come and how far we have yet to go-San Diego Union-Tribune
The biggest challenge ahead involves helping persons with HIV or those at risk who have little or no access to remedies like antiretroviral therapy.
BY DOUGLAS RICHMAN
DEC. 1, 2022 6 AM PT
Richman, M.D., is Distinguished Professor Emeritus of Pathology and Medicine at UC San Diego School of Medicine. He directs The HIV Institute and co-directs the Center for AIDS Research, both at UC San Diego. He lives in La Jolla.
Like diabetes, arthritis and heart disease, AIDS is a chronic condition.
In some ways, that simple statement is almost miraculous. Not so long ago, a diagnosis of AIDS was broadly considered to be a death sentence. It remains a very serious diagnosis, but AIDS is now a well-manageable disease, with treatments that can dramatically improve the quality and longevity of patients’ lives.
Getting to this point required a lot of people, labor, pain and science. In 1981, I was an assistant professor, seeing patients with infectious diseases and operating a research and diagnostic virology lab at the Veterans Administration Medical Center and UC San Diego School of Medicine. My focus was on influenza and herpes viruses, but that year, physicians in Los Angeles and New York began reporting cases of young, healthy homosexual men dying from a type of pneumonia that ordinarily would be limited to severely immunocompromised people, such as cancer patients undergoing chemotherapy. That year, my colleagues and I recognized similar cases in San Diego. It was the beginning of the AIDS epidemic and a long, fraught struggle to understand and manage the human immunodeficiency virus (HIV), which was at least as mysterious and terrifying then as the SARS-CoV-2 virus was at the beginning of the COVID-19 pandemic.
HIV was deadlier. Back then, within six months of becoming ill, at least half of those early patients diagnosed with HIV were likely to die. Within a few years, in 1992, HIV/AIDS would become the leading cause of death among men 25-44 years of age, surpassing heart disease, cancer, suicide and homicide. For attending physicians, it was hugely disheartening. We felt like battlefield doctors with the sick and dying coming in faster than we could treat them — if we could treat them at all.
The turning point came in the mid-1990s with the development of antiretroviral therapy that combined different drugs to suppress HIV replication, reducing the presence of the virus in patients to undetectable levels, resolving symptoms and preventing transmission.
Subsequent improvements have made antiretroviral therapy even more effective with few or no side effects. Most treatments now involve taking a single pill daily. Drugs are also available to prevent infection in those most at risk. New drugs in development may treat or prevent AIDS with administration only every six months or longer.
Rates of new HIV infections are declining. Prevention measures are improving, albeit unevenly among demographic groups. More than 1.2 million people in the U.S. now live with HIV, though not all are aware they are infected. As odd as it sounds, it is good news that the population of people with HIV is growing, but slowly, because new infections are no longer counterbalanced by AIDS-related deaths.
Such progress has required consistent, concerted effort by physicians and scientists across the country and around the world. At UC San Diego alone, there is the HIV Institute, the AntiViral Research Center, the Center for AIDS Research, the Owen Clinic at UC San Diego Health (which opened just one year into the epidemic) and dozens of researchers and programs, all focused on the perils of HIV and other deadly pathogens.
The biggest challenge ahead involves helping persons with HIV or those at risk who have little or no access to remedies like antiretroviral therapy. The World Health Organization estimates nearly 39 million people are infected with HIV. Approximately 650,000 die each year from HIV-related illnesses, more than 18,400 in the United States alone.
That’s an historical improvement, but HIV and AIDS still infect and kill too many because effective treatment remains out of reach for too many. More than 28 million people infected with HIV globally are now using antiretroviral therapy, but 10 million are not.
In the U.S., the HIV epidemic is now concentrated in socially marginalized and disenfranchised communities, with most HIV infections occurring in sexual minorities and in communities of color, among people lacking resources and advocacy. Socioeconomic status, education and financial security are all factors that weigh against them — just as they weigh against those with COVID-19, diabetes, heart disease and cancer.
The situation is similar around the world, just on a larger scale. In low- and middle-income countries with inadequate public health services, AIDS can still be a death sentence. Our work at home and abroad is not complete until everyone, everywhere can render AIDS a chronic condition. We have relearned from COVID-19 that infections do not respect boundaries.
Dec. 1 is World AIDS Day. It is a moment to remember where we have been and how far we have come. Nevertheless, we have a long way to go, because HIV/AIDS isn’t going away anytime soon.
UC San Diego HIV Institute receives $400,000 donation from Eugene R. Burkard Charitable Remainder Trust
La Jolla, CA: In October 2022, the UC San Diego HIV Institute received a $400,000 contribution from the Eugene R. Burkard Charitable Remainder Trust. Eugene (Gene) Raymond Burkard founded the International Male catalog and stores, one of San Diego's most successful businesses. With the advent of the HIV crisis, Mr. Burkard played an instrumental role in the San Diego community, including helping to start Mama’s Kitchen and serving on the board of the San Diego LGBT Community Center.
This generous bequest is the single largest gift The HIV Institute has received in its 26-year history. Since the 1980s, HIV/AIDS research at UC San Diego has been at the forefront of discoveries that shape treatment standards on a global scale. The Regents of the University of California established The HIV Institute in 1996 to coordinate UC San Diego’s diverse HIV/AIDS programs. Since then, the Institute has facilitated innovation and breakthroughs from laboratory bench to patients’ bedsides.
“We are honored that Mr. Burkard provided this landmark gift,” said Elizabeth Johnson, Administrative Director of The HIV Institute. “HIV will never cure itself, but we believe that we can end it with the help of community leaders and partnerships. Philanthropic partners such as Mr. Burkard are essential as we lead the charge toward expanding state-of-the-art, interdisciplinary HIV research and care.”
Mr. Burkard’s forward-thinking support and investment will help drive the next evolution of HIV research by supporting future generations of innovators, growing and empowering a team of exceptional scientists, and supporting discoveries that will create a future without HIV/AIDS.
“We hope Mr. Burkard and his loved ones take great comfort in knowing that this contribution will fuel discoveries that advance the diagnosis, treatment, and prevention of HIV,” said Douglas Richman, MD, Director of The HIV Institute. “Through his legacy, our physician-scientists will continue to unite basic science, translational research, and collaborative care to inspire greater hope and healing in the lives of all who live with and are affected by HIV.”
UC San Diego scientist shifts back to battle mode on virus / Infectious disease expert joins rush to learn more
UC San Diego scientist shifts back to battle mode on virus / Infectious disease expert joins rush to learn more about new variant threat.
Dr. Davey Smith was munching on popcorn, trying to enjoy a quiet lunch break two days after Thanksgiving, when an email popped open on his iPad with news that filled him with a deep, dark dread.
The chief of infectious diseases at UC San Diego was learning from colleagues in South Africa that Omicron, the new strain of COVID-19 that had been discovered there, might be a real troublemaker.
Days earlier, Smith thought they had simply found a contaminated sample, not a wily successor to COVID-19 and the Delta variant. New data proved otherwise. A fresh threat had arisen.
“I thought, ‘Oh, my God, could this be COVID 3.0?,’ ” said Smith. “Will the vaccines work against it? Will our drugs be effective? We need these tools. This is not where we wanted to end up.”
Smith is at the forefront of a dash by scientists at UCSD and elsewhere to answer those and other questions that could determine whether the world plunges back into another year of pandemic.
The news about Omicron was startling and disturbing, but not surprising to Smith, a 50-year-old physician-researcher who is conducting clinical trials on drugs designed to fight COVID-19, including tests now underway in South Africa.
Viruses mutate. It is a defining characteristic. You’ve got to keep up.
But the news came like a gut punch to the public.
There’s been a general feeling in recent months that the pandemic is fading away, even though many refuse to get vaccinated. The airlines carried 2.3 million passengers over Thanksgiving, a figure nearly as high as before the trouble started.
But the post-Thanksgiving vibe is one of great wariness among the public, and among scientists who are suddenly back on a war footing with an enemy that has killed 5.23 million people worldwide.
Researchers declared that Omicron, which is smaller than a particle of dust, would quickly spread around the globe. And it did.
The first case in the U.S. was reported on Wednesday in San Francisco. It involved a vaccinated man who’d recently traveled to South Africa. The following day, more cases popped up in California in other parts of the country. Late in the week, there were fresh reports from South Africa that Omicron can more easily cause reinfection and may spread much more rapidly than even the highly infectious Delta variant.
No one had immediate answers, including immunologist Kristian Anderson of Scripps Research, one of San Diego’s most respected life scientists.
His Twitter feed on Tuesday carried a deflating message: “Omicron — on a scale from 1-10, how bad is this going to be? This one’s a weirdo, so I’m a 3, a 10, or anything in-between.”
Scientists will soon have some partial answers — and, in a cruel twist, they’re likely to arrive right around Christmas and New Year’s.
In science hubs like San Diego, researchers are trying to figure out if Omicron has a powerful ability to overwhelm a vaccine’s defenses and cause infection and illness. They’re doing this by taking blood samples from people who are vaccinated, and those who’ve recently recovered from COVID-19, and exposing it to the new virus.
Scientists are able to use a synthetic version of Omicron — a so-called pseudovirus that contains all of the variant’s roughly 50 mutations. The technique produces results in about 10 days.
Researchers like Smith also are trying to obtain real versions of the variant. He spent much of the past week trying to get officials in South Africa and the U.S. to expedite matters.
Scientists are worried that Omicron crushes the antibodies that help prevent people from becoming infected. On the upside, many think that another key part of the immune system — T-cells — will vigorously battle illness caused by the virus. These cells determine a specific course of action for fighting foreign substances and help wage war.
That’s why researchers are relentlessly pushing vaccines and booster shots.
Scientists like Smith are using a similar blood-based approach to determine whether Omicron will neutralize the monoclonal antibodies that are part of some new therapeutic drugs.
Researchers are also examining the genetic makeup of Omicron, which has 50 mutations, far more than the dominant Delta strain. It’s not yet clear what each of the mutations do, alone or in concert. And some of the mutations are new to science. But there are some early insights.
“From the mutations that are being seen, pretty much everybody is predicting that the antibody response produced by (vaccines) will be decreased,” said Alessandro Sette, a researcher at the La Jolla Institute for Immunology.
“The question is will this also be the case for the T-cell response?”
The concern is that Omicron could, in some way, also weaken the counterattack launched by T-cells.
Scientists have emphasized publicly that they’re just getting their minds around Omicron and that it is possible that the strain is less threatening than it appears. And Sette noted that the problems the virus causes might be offset by booster shots.
Even so, Smith’s mind drifted into dark territory on Tuesday during an interview with the Union-Tribune. He brought up the “L” word, something no one wants to hear.
“I don’t know if this will lead to a lockdown, but there’s a chance we could got back to the bad times,” said Smith, a candid, plain-spoken man whose words have a lyricism that reflects his upbringing in Tennessee. “I don’t think it will get to that. But that’s what I worry about.”
He also said he could imagine a scenario in which American universities would have to push some of their classes back online if Omicron becomes a major problem.
He realizes that such remarks can rankle people; he shrugs it off, saying: “The virus doesn’t care about politics, and science shouldn’t either.”
His comments about universities did cause a bit of agita at UC San Diego, which earned acclaim over the past 18 months for producing one of the lowest campus infection rates in the country while simultaneously helping develop COVID-19 vaccines and drugs and inoculating hundreds of thousands of people.
The school opened with a record 42,875 students in September and, like other institutions, doesn’t want to backpedal.
“You don’t go from ‘there’s a new variant in South Africa’ to ‘don’t come back to campus after Christmas,’ ” said Dr. Robert Schooley, the infectious disease expert who has been running UCSD’s Return to Learn program, the protocols used to safely open the school.
“We’re about as well prepared for this as we’ve been for anything,” he said.
As he spoke, UCSD was sampling wastewater across the campus in its daily hunt for traces of the coronavirus. The surveillance program was introduced last year and now includes the search for Omicron.
Schooley was careful not to criticize Smith, who for years has been one of the most noted HIV researchers in the U.S. He’s also a physician — one who knows that positive change can come quickly.
In July 1996, he began using the famous HIV drug cocktails that Schooley, a researcher, helped to pioneer. Smith quickly went from watching patients die to becoming well enough to leave the hospital.
“The things we learned studying HIV set up everything we’re doing with COVID,” said Smith.
Shortly after the pandemic hit, Smith became part of Operation Warp Speed, the public-private partnership created by the Trump administration to develop vaccines, drugs and diagnostics to fight COVID-19.
He began running ACTIV-2, a major clinical trial to test the safety and efficacy of new therapeutics. That and other work has made him part of science’s inner circle.
Smith typically begins his 16-hour days at 5 a.m. on conference calls with members of the NIH, including Dr. Anthony Fauci. He keeps his Zoom camera dark so that he can get in a workout on the elliptical machine at his home in Mission Hills.
The meetings have taken on a heavy tone in recent days, a mood that contrasts with Smith’s normally sunny disposition.
“He’s the most optimistic person I’ve ever met,” said Dr. Susan Little, a UCSD infectious disease expert and physician who is running separate COVID vaccine trials on behalf of AstraZeneca and Janssen.
“He has a unique ability to see the good in everyone, the silver lining, to have patience and compassion.”
Those traits were being tested Friday as Smith boarded a plane for a science meeting in Mexico. There was news out of South Africa that Omicron had become the dominant COVID strain in some provinces.
“I think we are in as bad a spot as we were last year (at) this time,” Smith said by text as he headed south. “It is looking like late winter could be tough.
“Hopefully, the vaccine holds (and) helps keep people from needing to be hospitalized.”
The New York Times contributed to this story.
gary.robbins@sduniontribune.com
Top-10 Ranking for UC San Diego HIV/AIDS Specialty Training in
U.S. News & World “Best Medical Schools” Report
The HIV/AIDS training program in the UC San Diego School of Medicine holds a top-10 position once again in the “America’s Best Medical Schools” rankings from U.S.News & World Report.
U.S. News evaluates the nation’s medical schools every year for the quality of their training programs in research, primary care, and selected internal medicine specialties including HIV/AIDS.
The new rankings, released April 15, 2010, place the UC San Diego School of Medicine 10th in the nation in HIV/AIDS specialty training, 16th in research training, and 28th in primary care. A total of 122 medical schools are included in the rankings.
“The department’s clinical and research programs in HIV/AIDS have been a model for how the concerted efforts of faculty, fellows and support staff can make a major difference in the lives of patients with the devastating disease,” said Kenneth Kaushansky, M.D., M.A.C.P., Helen M. Ranney Distinguished Professor and Chair of the Department of Medicine.
In the HIV/AIDS specialty, the Department of Medicine offers research and clinical training via the teaching activities of the Division of General Internal Medicine and Division of Infectious Diseases.
Those divisions operate a variety of clinical and research entities including the Owen Clinic, the Antiviral Research Center, the AIDS Research Institute (now The HIV Institute), and the Center for AIDS Research.
“Over the years at UCSD, we have been fortunate in accumulating and retaining a remarkable group of outstanding clinicians, basic, translational and clinical investigators involved in the care and study of HIV/AIDS,” said Douglas D. Richman, M.D., Professor of Pathology and Medicine and the Florence Seeley Riford Chair in AIDS Research.
Dr. Richman, Director of the UCSD Center for AIDS Research, has served as principal investigator of UCSD’s AIDS training grant for many years.
“UCSD investigators have made remarkable contributions in the areas of treatment and pathogenesis,” he said. “In recent years, we have enhanced our strength with outstanding programs in epidemiology and global health.
“What is special about UCSD,” Dr. Richman said, “is the collaborative and interdisciplinary nature of HIV/AIDS research which has been fostered by our Center for AIDS Research.”
The UC San Diego School of Medicine has 1,035 full-time faculty members, of whom over 420 are in the Department of Medicine.
The Department’s 2009 research funding amounted to more than $113 million, not including grants received through the Moores UCSD Cancer Center, the San Diego VA Healthcare System, and the Veterans Medical Research Foundation.
The U.S. News rankings of medical specialties, including HIV/AIDS, are based on the opinions of medical school deans and senior faculty members who are asked to name the schools that offer the best training programs in each specialty.
UC San Diego School of Medicine Celebrates 50 Years
In the fall of 1968, UC San Diego School of Medicine (SOM) opened for business. Fifty years and several thousand newly minted doctors later, SOM is recognized among the best in the nation and in the world, in both research and in primary care. Throughout this year, SOM is celebrating this 50-years-in-the-making milestone with special events, news and features. You can keep informed by regularly visiting the new SOM home page at medschool.ucsd.edu.
Check out this year’s special issue of Discoveries magazine, which highlights many of the men, women, students and staff whose talents and achievements inspire, then and now. A digital version of the magazine can be found here.
HERE DISCOVERIES ARE DELIVERED
Medicine has evolved since the inaugural class entered in 1968, but our goal is constant: Create physicians and scientists who are as compassionate as they are brilliant.
San Diego Center for AIDS Research
Funding Renewed for an Old and On-Going Fight
Five-year, $15 million federal grant supports continued studies of HIV/AIDS at UC San Diego
April 16, 2018, | Scott LaFee
The National Institute of Allergy and Infectious Diseases has awarded a five-year, $15 million grant to the San Diego Center for AIDS Research (CFAR) at UC San Diego, renewing support that extends back to an original establishing grant in 1994-the height of the AIDS epidemic.
"The grant renewal represents NIAID's continued and enduring investment in our mission to be a critical regional resource in HIV research and education, to advance the discovery and development of new treatments and ultimately, to find a cure for AIDS," said Davey Smith, MD, the grant's principal investigator and new director of CFAR.
Smith, who is also chief of the division of infectious diseases and global public health and professor at UC San Diego School of Medicine, replaces Douglas Richman, MD, Distinguished Professor of Pathology and Medicine, who remains as a co-director at CFAR while also directing The HIV Institute at UC San Diego.
HIV/AIDS entered public consciousness in 1981 with the first reports of a rare, deadly infection in five young, previously healthy gay men, all living in Los Angeles. By year's end, there were 270 reported cases nationally of severe immune deficiency among gay men, with 121 deaths. The mysterious disease would get a name in 1982: acquired immune deficiency syndrome.
The next decade was marked by rapidly escalating numbers of diagnoses and deaths across the United States and globally. AIDS would afflict diverse demographic groups. In 1994, the disease would become the leading cause of death for all Americans ages 25 to 44, with the death toll reaching its all-time annual high of 48,371 in 1995.
CFAR was established by the NIAID as a regional, collaborative, frontline hub for studying HIV, bringing together multiple institutional partners, including The Scripps Research Institute, Sanford Burnham Prebys Medical Discovery Institute, and the La Jolla Institute for Allergy and Immunology.
Richman was a founding member of the SD CFAR in 1994—and a veteran in the war against HIV/AIDS. In 1981, he had been an assistant professor operating a diagnostic virology lab at UC San Diego School of Medicine. He saw many of the first cases of HIV/AIDS. "Those early years were hard," he said. "There were no treatments for HIV itself and therapies for infections that complicated AIDS were difficult and often ineffective." Richman served as CFAR co-director from 1994-2001 and was named director in 2001.
CFAR's mission focuses on finding a cure for HIV in those already infected and preventing HIV transmission to those not infected through multi-institutional research, community engagement, and training of future investigators and physicians. At UC San Diego, it is part of a larger coalition under the umbrella of The HIV Institute, which also encompasses the AntiViral Research Center, HIV Neurobehavioral Research Center, and the Owen Clinic at UC San Diego Health, one of the nation's first clinics dedicated to the treatment of HIV/AIDS patients.
"A lot has changed since HIV/AIDS first emerged," said Smith," especially in the last several years. We haven't yet found a cure, but there are now effective treatments capable of reducing AIDS to the status of a chronic but manageable condition, not unlike diabetes or hypertension. Thanks to work at places like CFAR and elsewhere, the mortality rate for AIDS is a shadow of what it once was."
In 2015, the most recent data available, there were 6,465 deaths in the United States attributed directly to HIV, according to the Centers for Disease Control and Prevention. It represented less than 15 percent of the U.S. death toll in 1995.