My research focuses on the pathogenesis and treatment of HIV and tuberculosis in resource poor settings including Haiti and Tanzania. HIV research initially focused upon treatment of opportunistic infections and then transitioned to studies of antiretroviral therapy (ART). I conducted the first…
more large trial of ART in a developing country. This study of the first one thousand patients with AIDS treated with ART in Haiti demonstrated treatment outcomes comparable to those achieved in the United States and provided rigorous scientific evidence in support of international efforts to make ART available to AIDS patients worldwide. I conducted a randomized clinical trial to determine the optimal time to initiate antiretroviral therapy in HIV infected adults. This trial demonstrated that early therapy decreases mortality four-fold and prompted the World Health Organization to change international HIV treatment guidelines. With antiretroviral therapy and longer survival, patients with HIV now suffer from chronic diseases including cancers and cardiovascular disease. I am conducting studies on the pathogenesis of HIV induced chronic inflammation with the goal of identifying new interventions for these long term complications of HIV. Tuberculosis research includes clinical trials to optimize treatment of latent and active TB with a focus on HIV co-infected patients. I conducted a randomized clinical trial in HIV infected adults demonstrating that, after the successful treatment of tuberculosis, post-treatment isoniazid prophylaxis decreased the risk of TB recurrence 5-fold. Current studies aim to understand the persistence of M. tuberculosis in the human host and to develop new drugs that kill non-replicating mycobacteria.
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