CFAR at Emory Newly Established Scientific Working Groups Leadership Announcement

CFAR at Emory Newly Established Scientific Working Groups Leadership Announcement

Health Equity Scientific Working Group

The central purpose of the Health Equity Scientific Working Group (SWG) is to expand NIH-funded community-engaged research to promote health equity at Emory in collaboration with Morehouse School of Medicine (SOM) and community stakeholders in the Atlanta area. Activities will include hosting research proposal feedback sessions, quarterly seminars, networking events, and/or career development sessions as opportunities for CFAR Members, Morehouse faculty, and community partners to interact; and pilot test several mentoring mechanisms focused on developing underrepresented minority investigators.

Rhonda Conerly Holliday, PhD, MA
Co‐Director, Health Equity SWG
Dr. Holliday (Rhonda) is an Associate Professor of Community Health and Preventive Medicine at the Morehouse School of Medicine. She is a public health researcher with a background in developmental psychology. Rhonda has extensive expertise in Community Based Participatory Research (CPBR), health equity, and health communications. Her topical areas of interest include HIV prevention among adolescents and emerging adults, including college students and justice-involved individuals. She is the PI for the core research project for the Morehouse School of Medicine Prevention Research Center (U48DP006411), focusing on implementing a CBPR approach to HIV prevention on the campuses of HBCUs and Minority Serving Institutions. Importantly for this SWG, she has published not only on the results of her CBPR projects, but also on the methods and lessons learned in developing and executing community-academic partnerships.

Sophia Hussen, MD, MPH
Co‐Director, Health Equity SWG
Dr. Hussen (Sophia) is an Associate Professor of Global Health in the Rollins School of Public Health at Emory University with a joint appointment in the Division of Infectious Diseases in the Emory University School of Medicine. Sophia is an infectious diseases physician and public health scientist who conducts research related to improving HIV and mental health outcomes for youth living with HIV, with a particular focus on young Black gay and bisexual men. She has recently completed a CDC-funded pilot trial of a CBPR-developed intervention to enhance social capital among young Black gay and bisexual men living with HIV, and she is also incorporating participatory methodologies into ongoing NIH-funded intervention development grants (R34MH124638; R34 MH116805) and exploratory mixed methods work (R21MH121164). Sophia also leads community engagement efforts within the Emory Clinical Trials Unit (CTU) and the Atlanta site of the MACS/WIHS CCS.

Alphonso Mills, BA
Co‐Director, Health Equity SWG
Mr. Mills (Alphonso) is a community health worker at Positive Impact Health Centers (PIHC), a large Atlanta community-based organization focusing on infectious diseases care, mental health care, substance use treatment, and other support services for people living with and at risk for HIV. Alphonso, who is openly living with HIV, has developed a strong track record of both professional and personal advocacy in the local Atlanta community. He is a 2020 graduate of Morehouse College, where he majored in psychology. He has also served on a Community Advisory Board for several of Dr. Hussen’s research projects since 2017. Due to the sum of his professional, research-related, and personal experiences over the last five years, Alphonso has extensive community connections with key organizations and individuals working in the HIV field in Atlanta. He also has experience with CBPR and other research as a participant, research assistant, and advisor.

Next Generation Therapeutics Scientific Working Group

The Next Generation Therapeutics Scientific Working Group (SWG) seeks to catalyze opportunities for team science within and across Emory CFAR institutions to set the foundation for future exploration and development of (i) novel approaches for viral suppression in people living with HIV using combinations of therapeutics that overcome drug resistance associated with current ART and are delivered as formulations designed to facilitate their long-term release; and (ii) immune-based strategies, focusing on those FDA-approved for other diseases, aimed at targeting and limiting HIV residual disease and HIV reservoirs. Activities will include hosting research proposal feedback sessions, educational, networking events, and/or career development sessions as opportunities for CFAR Members, CDC staff, and Georgia Tech and Morehouse School of Medicine faculty to interact; provide structured mentoring for Early-Stage Investigators in the field to ensure a robust scientific future; and promote multi-investigator applications to the CFAR Developmental Core and ultimately to the NIH.

Stefan G. Sarafianos, PhD
Co‐Director, Next Generation Therapeutics SWG
Dr. Sarafianos (Stefan) is the Nahmias-Schinazi Chair, Professor, and Associate Director of the Laboratory of Biochemical Pharmacology (LOBP) Division in the Department of Pediatrics at Emory. He studies viral replication at the molecular level, its inhibition, drug resistance, and the development of drugs that will treat human disease by novel mechanisms of action. Stefan has worked in retroviral structural biology, biochemistry, and virology since 1993 and has published more than 170 manuscripts. In early biochemical work he identified the HIV reverse transcriptase (RT) active site residues that are involved in dNTP, DNA, and PPi binding prior to any crystallographic information. His lab has had extensive contributions in the development of potent inhibitors that act by novel mechanisms of action including EFdA (islatravir), currently in Phase III clinical trials (for which he was recently awarded an NIH MERIT award) and in characterizing their mechanisms of inhibition and resistance. Stefan has worked in the HIV capsid field for several years now, and his lab was the first to solve the elusive crystal structure of the native (uncrosslinked) hexameric HIV capsid protein (CA) in apo form and in complex with CA-targeting antiviral PF74 (Science, 2015). This set of structures provided the framework for studies in which 45 crystal structures of the native CA hexamer were solved with mutations that affect capsid stability, and in complexes with host factor peptides and CA-targeting antivirals. Extensive biophysical and virological characterization revealed compounds with proprietary compounds that improved potency, resistance profiles, and metabolic stability compared to PF74. Some compounds can inhibit clinically-relevant PF74- and GS-6207-resistant HIV-1 strains.

Mirko Paiardini, PhD
Co-Director, Next Generation Therapeutics SWG
Dr. Paiardini (Mirko) is an Associate Professor of Pathology and Laboratory Medicine at Emory and a Researcher at Yerkes National Primate Research Center and the Emory Vaccine Center. For almost 20 years, Mirko has been involved in studies of AIDS pathogenesis in both HIV-infected individuals and in the models of SIV infection in rhesus macaques (RMs). Mirko gained extensive experience with in vivo studies of SIV infection of RMs in which virus replication is suppressed by a potent ART regimen, thus validating this model for studies of HIV cure. He led several studies in which in vivo immune interventions have been conducted in ART-suppressed SIV-infected RMs, aimed at reducing, and possibly eliminating, immune dysfunctions and HIV persistence in people living with HIV, including treatment with IL-21, IL-15 agonist, fingolimod, as well as blockade of PD-1, CTLA-4, and IL-10. More recently, his laboratory developed the NHP model of SARS-CoV-2 infection to test the therapeutic potential of baricitinib. He directs several NIH-funded studies of HIV immunology, pathogenesis, and persistence. He is the principal investigator of ERASE (Enterprise for Research and Advocacy to Stop and Eradicate) HIV, which is an NIH-funded international collaboratory aimed at developing therapeutic interventions to cure HIV infection.

Susan Pereira Ribeiro, PhD
Associate Director, Next Generation Therapeutics SWG
Dr. Ribeiro (Susan) is an Assistant Professor of Translational Medicine in the Department of Pathology at Emory University. She is an immunologist with experience in multi-omics approaches and with expertise in the development of cellular and immune assays and sophisticated flow cytometry models. Susan has focused in pathogenesis, progression and responses to immune therapy in order to discriminate mechanisms that leads to different outcomes in different individuals (Ex. Responders and Non-responders to immune therapy). She has experience with the cellular and molecular aspects of HIV immune pathogenesis and immunotherapies, focused on HIV reservoir evaluation, immune-phenotyping, and also vaccine development/response assessment, and in vitro efficacy of HIV-CAR T cells. Most recently her research has focused on understanding the mechanisms of HIV reservoir maintenance and the absence of CD4 T cell recovery in HIV infected subjects that show different clinical outcomes .

James Kohler, PhD
Associate Director, Next Generation Therapeutics SWG
Dr. Kohler (James) is an Assistant Professor Laboratory of Biochemical Pharmacology Division in the Department of Pediatrics at Emory. James has expertise in mucosal immunology, mouse transgenic models, pathogenesis (cardiac and renal) and toxicity models for HIV and antiviral therapies for human viral infections. His past training and research experience have included development and use of murine models to measure induction of mucosal immunity, signal transduction pathways associated in immune targets of HIV-1, tissue-specific antiretroviral toxicity, and HIV-1 cell-tropism and mutagenesis. James provides mentorship and co-leads the HIV Division of the Laboratory of Biochemical Pharmacology (Schinazi Lab). He previously served as Associate Director of the Emory CFAR HIV Cure SWG, now the HIV Cure Research Cluster.

TRAINING OPPORTUNITY: NIH T32 Openings for  Post-Doctoral Fellows at Emory University Emory Training Program in HIV Translational Research to End the Epidemic

TRAINING OPPORTUNITY: NIH T32 Openings for Post-Doctoral Fellows at Emory University Emory Training Program in HIV Translational Research to End the Epidemic

Fellow-driven & mentor-supported HIV transla tional research fellowships starting Jan 1, 2022

Are you a PhD, MD, MD/PhD graduate with an int erest in HIV Translational Research? Are you within seven years of your terminal degree? Are y ou a U.S. Citizen or Naturalized (Green Card) U.S. Citizen? Can you devote two years to training?

All trainees must commit full-time effort to th e program and its related research activities.

Eligible Areas of HIV Research

  • Laboratory-based science, vaccine, and cure research
  • Patient-centered clinical research
  • Public health and implementation science

Trainees will gain expertise in cross-cutting areas ofscience and translation to the Ending the HIV Epidemic Initiative

HIV T32 Program Trainees will Receive:

  • Annual stipend at appropriate NIH-specifiedlevel based on years of postdoc experience
  • Travel & childcare allotments; research supplies
  • Tuition support for formal didactic training intranslational research (MSCR, CPTR, or selectedgraduate level courses)
  • Hands-on translational research rotation

DEADLINE FOR SUBMISSION: November 30, 2021
Application Process:

1.  Applicants should identify a potential mentor from the list below arranged by focus area. Applicants mustcontact the potential mentor to see if the mentor is accepting new fellows through the Emory HIV T32 program.Applicants should include their CV and a brief description of the area of mutual interest.

2.  Potential candidates should complete an HIV T32 Interest Form to initiate discussion with the faculty ProgramDirector (PD) in the target area of interest regarding the candidate application: https://bit.ly/EmoryHIVT32
a. Laboratory-based basic science, vaccine, and cure research: Ann Chahroudi, MD, PhD
b .Patient-centered clinical research: Colleen Kelley, MD, MPH
c. Public health and implementation science: Patrick Sullivan, DVM, PhD

3.  Approval to apply must be obtained prior to November 15, 2021. Candidates are encouraged to apply aftermentor and program reviews are complete and approval is given.

To apply, submit an application package including the following documents as a single PDF via email to cfaradmin@emory.edu by 5 PM EST on November 30, 2021:

  • Cover letter specifying focus area of interest with statement of future goals for a career in HIV research. Applicantshould include personal qualifications for the fellowship and what they hope to gain from the fellowship;
  • Current CV or NIH biosketch;
  • A letter of support from the proposed HIV T32 mentor;
  • Letter(s) of support from one other scientist (e.g. recent supervisor, mentor, or a collaborator);
  • A two-page description of the proposed research project and proposed didactic training plan (includinggraphs/figures but not references);
  • MD applicants from clinical departments must also provide a letter from the applicant’s Department/DivisionChair, indicating departmental commitment to provide at least 75% protected time for the trainee applicant todevote to the proposed research project. This letter can be same as the required letter of support from one otherscientist, described above.
LEEP more effectively clears high-risk HPV in HIV+ women

LEEP more effectively clears high-risk HPV in HIV+ women

Featured article in Emory Report
By Shannon McCaffrey | Woodruff Health Sciences Center | Aug. 25, 2021

A new study published in JAMA Oncology by Winship Cancer Institute of Emory University’s Michael H. Chung, MD, MPH, and colleagues, finds that loop electrosurgical procedure (LEEP) is more effective than cryotherapy in clearing high-risk human papillomavirus (hrHPV) in women living with HIV. Chung is a professor of infectious diseases at Emory University School of Medicine, and a professor of global health and epidemiology at Rollins School of Public Health.

The study drew upon data for 354 HIV-infected women recruited from the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya—which Chung cofounded. It set out to determine which modality is more effective at clearing hrHPV, and whether persistent hrHPV is associated with recurrent cervical cancer.

Half the women were randomly assigned to receive cryotherapy and the other half to receive LEEP.

The women were followed every six months for two years with hrHPV cervical swab and Pap tests. Persistent hrHPV detection was associated with a substantially greater risk of recurrent cervical cancer even after controlling for immune status, HIV viral suppression, and type of intervention. Over the 24 months, significantly more women treated with LEEP cleared the hrHPV than those treated with cryotherapy. LEEP was also better at preventing recurrent cervical cancer.

“Our study showed that when treating pre-cancerous cervical lesions in HIV-infected women, LEEP should be the preferred option instead of cryotherapy,” said Chung. “In addition, HPV testing for HIV-infected women is reasonable to do to determine whether the treatment has been successful and can be done as early as 6 months after the intervention.”

HPV is the most common sexually transmitted infection. It is associated with cervical cancer in women and genital warts in both women and men. Women living with HIV who also have certain types of cancer-causing HPV are at higher risk of developing cervical cancer, one of the illnesses that define advanced untreated HIV disease, or AIDS.

Cervical cancer is the fourth most frequently diagnosed cancer among women worldwide, and the most common cause of cancer death among women in sub-Saharan Africa. Women living with HIV have a higher rate of hrHPV than the general population, and are more likely to have persistent hrHPV infection leading to cervical intraepithelial neoplasia (CIN), abnormal growth of cells on the surface of the cervix that can potentially lead to cervical cancer.

It’s helpful to understand hrHPV and HIV coinfection to determine the usefulness of hrHPV testing to prevent cervical cancer among women living with HIV. The World Health Organization (WHO) and many national guidelines recommend testing for hrHPV as a primary cervical cancer screening tool in both high-income, middle- and low-income countries. Testing for hrHPV also is used to screen for recurrent disease after treatment for precancerous cervical lesions, and to help define the frequency and duration of follow-up.

Women in high-income countries with CIN grade 2 and higher are often treated with LEEP, which excises the lesions and surrounding tissue. In low- and middle-income countries, inexpensive and less technically complex cryotherapy is used to freeze the area around the lesion. Neither approach completely treats CIN or clears hrHPV infection, particularly for HIV-positive women. This is why it was important to compare LEEP and cryotherapy outcomes, and to determine whether one or the other is most effective at clearing cervical hrHPV infection, as well as whether persistent hrHPV is associated with recurrent CIN.

“Current clinical practice to treat pre-cancerous cervical lesions in LMIC’s [low- and middle-income countries] largely rests on using cryotherapy,” said Chung, “which is easier and less expensive to administer than LEEP. Clinical practice in LMIC should try to prioritize LEEP over cryotherapy when treating HIV-infected women to achieve the best clinical outcomes.”

Grant support was provided by the President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention under cooperative agreements GH002036 and GH002001.

Other collaborators involved in this study are from the University of Washington, Seattle; Ghent University, Ghent, Belgium; International Agency for Research on Cancer/World Health Organization, Lyon, France; Kenya Medical Research Institute, Nairobi, Kenya; Centers for Disease Control and Prevention, Atlanta; Coptic Hospital, Nairobi, Kenya; and Aga Khan University, Nairobi, Kenya.

Photo:  Michael H. Chung, MD, MPH co-founded the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, from which 354 HIV-infected women were recruited for the study. Photo: Paul Brown, University of Washington

Lessons from 40 years of HIV/AIDS

Lessons from 40 years of HIV/AIDS

Featured article in Emory Report
By Martha McKenzie | Emory Report | June 1, 2021

Forty years ago, on June 5, 1981, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) carried a report of five otherwise healthy gay men in Los Angeles who suffered from a rare form of pneumonia. Two had died.

James Curran, an epidemiologist in the CDC’s Sexually Transmitted Disease Control Division at the time, was asked to review the report before it was published. That was his first glimpse at the disease that would roil the world and define his career: acquired immunodeficiency syndrome (AIDS).

Soon after the report was published, Curran, now dean of Emory University’s Rollins School of Public Health, was asked to chair a task force organized to investigate the cause of this unusual outbreak. He was detailed to the investigative team for 90 days. The assignment lasted 15 years.

The task force’s first order of business was to establish a case definition, determine how the disease spread, and develop prevention recommendations.

“In those early days it was all boots-on-the-ground surveillance,” says Curran. “We tried to identify and follow everyone who fit the description, which soon included other opportunistic infections and a rare cancer called Kaposi’s sarcoma in addition to Pneumocystis pneumonia. We were trying to answer questions like, did these cases only occur in gay men? Were they limited to California and New York? Were they always fatal?”

Within weeks, Curran’s team confirmed more than 25 additional cases. The case definition the team put together based on their discoveries was adopted worldwide, allowing early and consistent recognition of the global AIDS epidemic.

It took two years for the cause of AIDS — a novel retrovirus eventually named human immunodeficiency virus (HIV) — to be identified.

Since then, vast progress has been made in diagnosis, prevention and treatment. Drugs developed at Emory — Emtriva and Epivir — are among the most widely used to suppress viral loads in infected people. The development of pre-exposure prophylaxis (PrEP) offered HIV-negative people effective protection from contracting the virus. Over the decades, AIDS went from being a death sentence to a chronic, life-long condition that could be managed with the correct medications.

In 1995 Curran left the CDC to become the dean of the Rollins School of Health, but he continued working in AIDS as co-director of the Emory Center for AIDS Research (CFAR). On the 40th anniversary of the first published account of AIDS, he reflects on the progress that has been made and what lies ahead.

“We’ve come so very far, yet there are about 38 million people worldwide living with HIV,” says Curran. “It’s a silent disease, so there are many more than 100,000 people in the U.S. who are infected but don’t know it. We’ve been able to reduce mortality and slow the transmission rate, but current therapy is not curative and must be continued for life. We can’t talk about totally eliminating AIDS until we’ve developed a vaccine and curative therapy. These remain important priorities for our current CFAR scientists.”

Still, the history of AIDS offers positive lessons. Though the beginning of epidemic was characterized by fear and homophobia, with President Ronald Reagan refusing to speak publicly about AIDS for nearly six years, a commitment to fight the disease prevailed. The George W. Bush administration established the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to bring relief, including heavily discounted drugs, to Africa and Asia, which suffered disproportionately.

“That global philanthropic commitment has saved tens of millions of lives,” says Curran.

Governments would do well to heed this lesson, especially in the face of wealthier nations hoarding COVID-19 vaccines.

“One thing AIDS taught us, and subsequently Ebola and Zika: Pathogens do not respect national boundaries,” says Curran. “If we want to keep ourselves safe, we have to keep everyone safe.”

Soon after the CDC reported the first cases of what would come to be known as AIDS, epidemiologist James Curran, shown here at the CDC in 1985, was asked to chair a task force to investigate the cause. Curran became dean of Emory’s Rollins School of Public Health in 1995. Photo by Steve Ringman/San Francisco Chronicle via Getty Images.

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