Research

Research activities in the Section of Infectious Diseases and Geographical Medicine are quite diverse. Investigations range from epidemiology, outbreak investigation-often utilizing state-of-the-art molecular methods for strain typing, clinical trials, and basic laboratory studies. Active epidemiologic investigations include the epidemiology of VRE in the Bone Marrow Transplant unit, epidemiology of other antibiotic-resistant pathogens, and risk factor analysis for hospital-acquired fungal infections. Clinical studies include determining factors that affect adherence with antiretroviral regimens, studies of new antiretroviral therapies for HIV infection, and studies of the safety and efficacy of new antimicrobial agents. The section is collaborating with Transplant Surgery in a multi-center study of solid organ transplantation in HIV-infected patients. There is also translational research in immunodeficiency states, with laboratory studies of ex vivo leukocyte apoptosis and immune reconstitution in HIV infection and phagocytic cell function in transplant recipients. Basic lab investigations into the mechanisms of probiotic formulations in inflammatory bowel disease are also being conducted in a collaborative effort with the Section of Gastroenterology. There is a commitment to expand the basic laboratory program in Infectious Diseases, with an active search underway for a Clinical Scientist.

Education and Training

The faculty members of Infectious Diseases and Geographical Medicine are deeply involved in teaching. The faculty is recognized as outstanding educators, within the institution and across the country. The group is active in courses for the medical school, both clinical teaching, at the bedside in the hospital and in the clinics, and didactics in a number of the basic science courses. We offer a course for fourth year medical students on HIV/AIDS. Residents in the Internal Medicine Residency program rotate on both in patient consult services and receive training in outpatient infections, with an emphasis on HIV, during their ambulatory care rotations. In FY07 the Section developed a Geographical Medicine Scholars Program that offers an international health curriculum and in-country practicum for residents and medical students. Faculty members are also active participants in a number of departmental and residency program conferences, and several faculty are regular invitees to Medical Residents Morning report. Finally, the Section of Infectious Diseases and Geographical Medicine offers a robust program in fellowship training with 2 slots available per year.

Clinical Activities

The Infectious Diseases and Geographical Medicine inpatient consultation services are the busiest in the institution. The variety of infections seen in this large, tertiary medical center is truly amazing and requires the input of sub-specialists from our section. In response to clinical need and and provide greater continuity of care, the consultation service is divided between two services, the General Infectious Disease Service and a second consultation service, the Immunocompromised Host Service. The latter service provides expert advice on the management of infections complicating cancer therapy and transplantation, both bone marrow and solid organ.

In the ambulatory clinic our physicians manage a wide variety of infections. Patients with chronic infections or acute infections requiring follow up after hospital discharge can receive care. In addition, patients with unusual immune deficiencies, congenital and acquired, can be diagnosed and managed. This includes comprehensive care for patients living with HIV infection. In addition , there is a Travel Clinic, with comprehensive programs for providing education and preventive medicine to assure that travelers avoid tropical diseases and expert help in evaluating and managing imported diseases.

The Infectious Diseases and Geographical Medicine section has developed a comprehensive Adult HIV Care Program, both for clinical care and clinical research. In the last year the section has received Ryan White Title 3 for Capacity Building grant. The goal is to expand the care of indigent patients in the outpatient setting for all patients who access care at UCH, offering them all the benefits or improved therapies and preventive medicine and keeping them healthy and avoiding hospitalization. The section has also been selected as a site for the CPCRA (Community Clinical Research) a clinical trials consortium funded by the NIH. Other clinical trials funded by industry, both multi-center trials and local investigator-initiated trials, are quite active. The adult program is integrated with the Pediatric AIDS/HIV Care Treatment Program and the Women’s Program, allowing comprehensive primary and tertiary care for families with members living with HIV infection.

The Section of Infectious Diseases and Geographical Medicine supports the institution in many other ways. Other contributions include oversight of the Antibiotic Restriction Program, a service designed to help prevent the development of antibiotic resistance and foster cost-effective antimicrobial therapy. The section also participates in Institution Biosafety Committee activities, assuring that there is a safe environment not only in clinical care areas, but also for investigators and other laboratory workers in the basic sciences laboratories.