HIV and Hepatitis C

Introduction

Boston Medical Center provides unique opportunities to investigate the epidemiology, outcomes, immunology, and virology of both HIV and HCV infections. We serve one of the largest populations of HIV-infected patients in Massachusetts, with over 1,800 patients enrolled in our outpatient practice, and over 5,000 HCV-infected patients engaged with care at BMC. Further, our faculty manages mature, well-characterized cohorts in Brazil, Uganda, India, and Eastern Europe, with special focus on HIV-TB co-infection, illicit substance use, and alcoholism. Infectious Diseases fellows interested in building a career as an HIV and/or HCV clinician-scientist will benefit from the breadth and depth of our experience.

 

Program Goals:

  • Develop expert clinicians who are prepared to become leaders in HIV and HCV care in the U.S. and in resource limited settings.
  • Train world-class clinician scientists who graduate our program in outstanding position to become independent investigators in an academic setting.

Program Objectives:

  • Complete a 2-year continuity outpatient practice experience focused on HIV and HCV
  • Present at least one poster at an academic conference such as the Conference on Retroviruses and Opportunistic Infections, the International AIDS Society, or the American Association for the Study of Liver Diseases “Liver meeting.”
  • Publish at least one first-authored publication in a peer-reviewed journal
  • Complete the one-page specific aims for an NIH career development award (K award)

 

Overview

The focus of the HIV/HCV concentration is primarily clinical training in the first year, combined with planning for increasing research emphasis in years 2 and 3. Year two of the fellowship is largely dedicated to scientific investigation, with ongoing continuity care experience in our outpatient clinic. Those who elect to pursue a career as a grant-funded HIV and/or HCV investigator will work closely with mentors to secure funding for a third and possibly fourth year of research training, during which time they will develop advanced skills and prepare an NIH career development award. Boston University has a diverse faculty that conducts nationally and internationally recognized research in HIV/HCV. Fellows can choose to pursue laboratory based research or clinical epidemiological investigations in HIV/HCV. Fellows are encouraged to also explore potential research opportunities outside the Division of Infectious Diseases, such as the Boston University, Department of Microbiology or Boston University School of Public Health.

Year One

During the first year, fellows interested in the HIV/HCV track will rotate through the infectious disease consult and inpatient services similar to the other trainees in the program.  Elective time in the first year will be dedicated to planning to apply for funding in the second year of fellowship.  During this time, fellows will be expected to meet regularly with the identified mentor.  This time will be dedicated to gaining a greater understanding of the research of interest and starting to accumulate preliminary data for future grant applications.

Year Two

During the second year, trainees’ primary responsibility will be working on their research project and applying for independent funding; they will continue with one outpatient clinic session and complete remaining inpatient consult service duties.  Fellows may elect to do additional clinical activities relevant to this track – for example, participate in relevant ambulatory electives in HIV and HCV care, or obtain training in Addiction Medicine.

Currently we have multiple training grant opportunities in both the basic and clinical sciences, as well as a track record of working with trainees to obtain research funding.

Year Three

Fellows will devote 100% of their time to their research efforts. The primary goal of the third year is to complete and publish ongoing work such that the fellow is in an outstanding position to apply for an NIH career development award, or similar foundation funding.

 

Combined Infectious Disease and Addiction Medicine Fellowship

The Section of Infectious Disease and the Grayken Center collaborate to offer a three-year combined fellowship in Infectious Disease and Addiction Medicine. The first year of fellowship will be primarily focused on clinical infectious disease, the second year focused on clinical addiction medicine, and the third year will be focused on mentored research training that combines both disciplines. For more information about the Addiction Medicine program, please see the program’s website. We will arrange for interested applicants to interview with Addiction Medicine faculty at the time of your visit to our program. Applicants accepted into the combined Infectious Disease-Addiction Medicine training will also be asked to consider applying to the NIDA-funded Fellow Immersion Training program in Addiction Medicine. This 4-day immersion program is designed for incoming subspecialty fellows with an interest in addiction science.

 

Mentored postdoctoral research training programs (T32 training grants)

The Boston University Clinical HIV/AIDS Research Training (BU-CHART) Program at Boston Medical Center is a two-year mentored postdoctoral research training program designed for physicians and other health scientists to enable them to conduct high -quality, ethical HIV/AIDS research focused on disadvantaged populations. This structured program includes didactic lectures in HIV/AIDS, classroom work and a mentored thesis leading to the MSc or PhD degree in Epidemiology, ethics coursework and mentoring and a series of Clinical Research seminars as part of the Boston University CREST Program. The candidate’s research will focus on one of four specific subject areas where BU has particular strengths: Opportunistic Diseases, Adherence and Natural History, Substance Use and Transmission.

The Integrated Care for Addiction, HIV and HCV Research and Education (ICAHRE) is a two-year mentored Postdoctoral research training program designed to provide rigorous interdisciplinary pre-doctoral and post-doctoral training in health services research related to addiction and HIV or addiction and HIV/HCV co-infection; mentor trainees to conduct studies that involve the development, testing and implementation of strategies to improve HIV testing, linkage, and adherence to care, and use integrated approaches to service delivery related to substance use and co-occurring HIV and HCV; and prepare trainees to disseminate research findings and translate them into practice and policy.

 

Cohorts and datasets with which fellows can develop projects

Boston ARCH 

The Boston Cohort is a prospective observational investigation of the effects of alcohol on people with HIV infection who may be affected by multiple substances of abuse (i.e. other drugs). The Cohort also serves as a platform for intervention trials. In its initial implementation, the project is designed to answer the research question: is unhealthy alcohol use associated with osteopenia in HIV-infected adults

Europe ARCH

The Russian Cohort aims to assess the longitudinal association between alcohol consumption and biomarkers of microbial translocation (sCD14) and inflammation/altered coagulation (D-dimer) in a cohort of HIV-infected drinkers in St. Petersburg, Russia.

India and Brazil Tuberculosis cohorts

Please see our description of the Global Health and Tuberculosis concentration for more information.

Boston Medical Center Virtual HCV Cohort

The BMC virtual HCV cohort s an EMR-based prospective cohort of all patients with reactive HCV Ab at Boston Medical Center. Data elements include clinical visits, laboratory tests, and pharmacy data. The data set is well suited for analyses of HCV care delivery in the “real-world,” as well as comparative effectiveness research.

AIDS Clinical Trials Group (ACTG)

The ACTG is a large, international clinical trials network dedicated to investigation of HIV therapeutics. The ACTG maintains a registry of all data elements collected as part of clinical trials, as well as banked plasma and PBMCs for some protocols. The ACTG is committed to working with new investigators, and welcomes proposals for novel analyses using ACTG registries. Our faculty have experience working with ACTG data, and can help fellows navigate the proposal process.

 

Potential Mentors

Boston University has a diverse faculty that conducts nationally and internationally recognized research in HIV/HCV.  Fellows can choose to pursue laboratory based research or clinical epidemiological investigations in HIV/HCV.  Fellows are encouraged to also explore potential research opportunities outside the Division of Infectious Diseases, such as the Boston University, Department of Microbiology or Boston University School of Public Health.

Faculty with laboratory based research

Andrew Henderson, PhD: HIV latency and persistence

Manish Sagar, MD: HIV/HCV transmission

Suryaram Gummuluru, PhD: HIV and dendritic cell biology

Gregory Viglianti, PhD: HIV and macrophage biology

Deborah Anderson, PhD: HIV secretion in the genital tract

 Faculty with clinical epidemiological based interests

Benjamin Linas, MD, MPH: HCV diagnosis, care cascade and treatment cost effectiveness

Nina Lin, MD: Director HIV/HCV clinical trials

Meg Sullivan, MD: HIV maternal fetal transmission.

Jeffrey Samet, MD, MA, MPH: HIV and alcoholism

Mari-Lynn Drainoni, PhD: qualitative approaches to investigating HIV and HCV outcomes

Alex Walley, MD, MSc: substance abuse treatment in HIV and HCV-infected patients