MUSC physician reflects on HIV/AIDS progress

By Janie Thomas

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Thirty-four years ago, the world recognized HIV/AIDS for the first time. The disease disrupted long-standing medical and public health advances. The research community scrambled for answers. The disease—for some time—caused widespread confusion and hysteria due to misinformation about its origin, the natural history of the virus, and the supposed demographics impacted.

J. Michael Kilby, M.D., Professor and Chief of the Medical University of South Carolina (MUSC) Infectious Disease Division, entered the medical profession at the peak of the HIV/AIDS epidemic and joined many other medical professionals in the hunt for the cause and treatment of this new disease. “There was a demand for specialized infectious disease knowledge during a time when the cause and the route of transmission of this disease were poorly understood,” said Kilby. “It was an exciting but somber time—I wanted to take part in contributing to the growing knowledge base and a viable solution.” Watching the prognosis of HIV/AIDS shift from imminent death to a long, relatively healthy life with the right regimen of medicines has made working in this once-seemingly hopeless area of medicine more worthwhile and fulfilling.

Kilby has been involved with HIV/AIDS research from the beginning of his career at the University of Alabama, Birmingham (UAB), including a program project funded by a National Institutes of Health (NIH) grant, he directed from 2002 to 2007 relating to the earliest immunologic and virologic events following initial transmission of HIV infection. One component of this large collaborative project involved enrollment and serial study of serodiscordant couples (one spouse infected with HIV and one not) in Zambia. “The time I spent working with researchers in Zambia taught me many lessons, one of the most important being to appreciate the vast amount of resources available to patients in the United States,” said Kilby.

He has continued to contribute to HIV/AIDS research by focusing on clinical and translational trials, funded by NIH, CDC, and pharmaceutical companies such as Gilead and GlaxoSmithKline. Recent breakthroughs in HIV treatment have made therapy much more convenient and simple (often just a single tablet a day, due to co-formulation of multiple medications in one pill), and these improvements have demonstrated that widespread treatment is one of the most effective forms of prevention, because patients with suppressed viral levels are much less likely to transmit the infection to others. Whereas some were skeptical that adherence to HIV therapy would be problematic in regions with limited resources, some studies even suggest adherence is better in Africa than in the US. “Nothing is worse than taking your medications the wrong way,” said Kilby. “So many complications can be avoided if patients simply make it a habit to take their medication as prescribed. Erratic adherence leads to the resistant virus that becomes much more challenging to treat in the future." Most HIV/AIDS patients no longer have the hassle of taking multiple pills each day (Kilby remembers when ~50 pills per day were quite common in this setting) to suppress their infections. Kilby works to educate his patients on the importance of treatment adherence to avoid the complications that arise from drug resistance. Even more important than treatment strategies is the initial identification of those who were HIV infected and were not aware.

Kilby and his colleagues at MUSC have assisted in implementing an HIV/AIDS opt-out testing policy in the emergency department to minimize the stigma associated with the test and catch the disease early enough to administer timely, efficacious treatments. His group also offers rapid, “point of care” HIV testing for partners or friends of patients, or others interested in finding out their status on campus. One of the future goals for Kilby and others involved in HIV/AIDS research is to end the stigma of testing for HIV/AIDS by integrating it into the routine of other health screenings, simply making it as normal as checking a patient’s weight, blood pressure or hemoglobin A1C. Although developing an HIV vaccine has been very challenging, Kilby notes important new insights have been developed and research is ongoing on this important front. “We’re seeing monumental successes in HIV/AIDS treatments,” said Kilby. “The so-called Berlin Patient and others who may have been cured by bone marrow transplants; the groundbreaking clinical trials showing that pre-exposure prophylaxis and community-wide therapy programs can drastically reduce transmission rates. These interventions are more promising than vaccines at present, in part because the virus can mutate and escape from immunizations (in much the same way that influenza changes each year, requiring annual changes in vaccines, but at a rate of change ~1000-fold greater).

As research shows, it takes innovation, preparation, and an enterprising spirit for progress to be realized. Kilby supports global health initiatives at MUSC not only to attract the best students, trainees and faculty, but because the global community has a shared interest in minimizing the spread of infectious disease. “Innovation is not bound by borders or oceans; MUSC can play an important role in combating global health challenges like HIV every day,” said Kilby.

According to Kilby, students and faculty considering MUSC often ask about the university’s global presence. He shares that it is an important consideration for the university to recognize the draw of global programs. As MUSC continues to develop a global presence through the Center for Global Health and the increasing amount of faculty working abroad, our caregivers and researchers will likely expose themselves to a new group of professionals with the desire to collaborate no matter the geography. “The best recruits for programs at MUSC are asking questions about MUSC’s involvement with global health because they are interested in investing their time and education into global medicine,” said Kilby. “If we want to attract great minds to choose MUSC, we need to provide global options for them.”

Janie Thomas is an intern in MUSC Center for Global Health