Message from the Vice Chair for Research
Infectious Diseases is highlighted this September. Our Division of Infectious Diseases, led by Division Director Dr. Myron Cohen, has significant impact here in North Carolina, as well as globally through the UNC Institute for Global Health and Infectious Diseases. The more than 75 affiliated faculty members work on four continents to solve global health problems, and present opportunities for training and research to physicians and scientists throughout the world. The ID faculty are renowned for their approaches to HIV prevention and treatment, and we have the largest AIDS cure initiative in the country. We also have faculty who work on malaria, Zika and Ebola, to highlight but a few of the fascinating pathologic microbes in the 21st century. Along with studies of global epidemics, our faculty are funded in research exploring innate immunity and responses to the more typical infections of hospitalized patients. The Division of Infectious Diseases is continually adapting itself to the global microbiology and its association with the global population – and will continue to be a critical bridge to tomorrow’s medicine. I’m proud to be able to introduce a few of the ID faculty on the DOM web page. Please also check out our latest Chair's Corner podcast featuring Dr. David Margolis and Dr. Allison Mathews in a talk about HIV cure research - you can listen to it here.
Janet Rubin, MD
Vice Chair for Research
David Alain Wohl, MD
That there are only a handful of Ebola-ologists in the world is something that Dr. Wohl, the Site Leader of the UNC AIDS Clinical Trials Unit at Chapel Hill, realized when the massive Ebola outbreak started to peak in 2014. Ebola raged across West Africa and cases were popping up in Europe and the US. Dr. Wohl led a coordinated effort in partnership with Dr. William Fischer II, a UNC critical care physician who had worked in an Ebola treatment unit in Guinea early in the outbreak, to test therapeutic approaches to Ebola and increase the standard of clinical care of those infected with the virus.
An HIV clinician and clinical researcher, Dr. Wohl saw parallels between HIV and Ebola, including the profound fear both viruses provoked when first emerging and the stigmatization of those surviving the diseases. Dr. Wohl envisioned that the same strategies and tools used to confront HIV could be brought to bear against Ebola. In the fall of 2014, Drs. Wohl and Fischer travelled to Liberia and launched the first-ever clinical trial of a therapeutic intervention for Ebola in Africa. Using plasma from survivors, they treated those with acute Ebola to jump start their immune response – a treatment most every Western healthcare worker infected with Ebola received after being repatriated to the US and Europe for care. In the process, they also brought handheld diagnostics to the field so that physicians could monitor blood chemistries of all patients at the center with acute Ebola.
With the waning of the outbreak, the pair have turned their attention to the survivors. They have learned that survivors continue to experience lasting effects such as muscle and joint pains, visual problems, and fatigue, as well as being ostracized on their return home. With the assistance of the Bill and Melinda Gates Foundation, Drs. Wohl and Fischer established a cohort of 330 Ebola survivors to assess longitudinal symptoms and systemic markers of immune response and inflammation. With reports of sexual transmission of Ebola, they built on UNC research into genital compartmentalization of viruses (e.g., HIV) and began collecting semen and vaginal fluid from Ebola survivors. In collaboration with UNC’s Amy James, they developed the first validated PCR assay for Ebola in genital fluids.
The team realizes that recovery from the massive Ebola epidemic of 2013-2016 is only a hiatus: there have been over 20 Ebola outbreaks since the virus was first discovered 40 years ago, and there will surely be more. In anticipation of the “coming plague,” Drs. Wohl and Fischer are working with the National Institute of Allergy and Infectious Diseases (NIAID) in developing a novel antiviral active against Ebola made by Gilead; they are currently working to determine if this drug can eliminate persistent Ebola RNA in the semen of survivors to prevent ongoing sexual transmission. Planning the clinical and research response to the next outbreak, Dr. Wohl works with governmental and non-governmental partners to be ready whenever and wherever Ebola strikes next.
Ann Dennis, MD
Dr. Dennis’ research bridges basic, clinical and epidemiologic science by using HIV-1 molecular epidemiology and phylogenetics to understand HIV transmission on a population level. The Southeastern United States is now considered the epicenter of the U.S. epidemic. Despite comprehensive HIV prevention measures including widespread antiretroviral therapy, over 1,000 new HIV diagnoses are reported annually in North Carolina. Innovative measures are needed to successfully reduce HIV incidence. HIV epidemics are composed of overlapping sub-epidemics defined by risk groups, geography, social interaction and time. A better understanding of local or sub-epidemics through more precise characterization of viral spread (molecular epidemiology) in populations can help guide where interventions are likely to have the greatest impact. Dr. Dennis’ research goals are to uncover the links between these sub-epidemics to facilitate the design of timely, effective interventions.
As an infectious diseases physician, Dr. Dennis is skilled in HIV clinical management lending her research practical, clinical grounding and relevance. After receiving an undergraduate and master’s degree in engineering, Dr. Dennis’ interest in public health led her to medical school and projects extending from the Navajo reservation to Botswana, and ultimately, UNC where she completed a fellowship in infectious diseases.
Dr. Dennis’ research takes advantage of multidisciplinary collaborations at UNC, the NC Department of Public Health and abroad. For the past two years, she has been supported by an NIH (NIAID) K08 Career Development award. She has received research funding from NC TraCS, and the UNC Center for AIDS Research. Using HIV-1 pol sequences derived from routine drug-resistance genotypes, her team has integrated HIV phylogenetic analyses with clinical data to characterize transmission networks in NC, to assess the success of social network recruitment to uncover transmission networks, and to implement studies of HIV transmission dynamics. Her current research focuses on, 1) detecting growing transmission networks over time among 15,000 HIV infections in NC, 2) evaluating the overlap between phylogenetic and sexual networks uncovered by contact tracing to identify transmission “hotspots,” 3) temporal trends and predictors of transmitted antiretroviral drug resistance, and 4) exploring methods to detect recently acquired HIV infection. These results ultimately direct testing resources, and HIV treatment and prevention.
Jonathan Juliano, MD, MSPH, DTM&H
Dr. Juliano is a tropical infectious diseases expert and a leader in the study of malaria genomics and the evolution of drug-resistant infections. After earning his medical degree at UNC, he trained in medicine-pediatrics at the University of Minnesota. Returning to UNC for ID fellowship he also received a Diploma of Tropical Medicine and Hygiene from the Gorgas Memorial Institute in Lima, Peru. He is now Associate Professor of Medicine with appointments in the Department of Epidemiology at the UNC Gillings School of Global Public Health and in the Curriculum of Genetics and Molecular Biology. He is a key part of the ID Fellowship Program here and is the founding Medical Director of the Antimicrobial Stewardship Team at UNC Hospitals.
Dr. Juliano’s research focuses on malaria. His interests include the molecular epidemiology of drug resistance and understanding the underlying ecological and evolutionary factors that drive the spread of disease and drug resistance. He has pioneered the use of advanced genetic methodologies, including next-generation sequencing, to study malaria. His early work sought to define the impact of host diversity on clinical trials. Dr. Juliano’s research group was the first to describe the presence of low level malarial variants with drug resistance that have the potential to act as a reservoir of drug resistance in a population. Dr. Juliano used next-generation sequencing techniques to demonstrate that World Health Organization-recommended genotyping methods can miss minority variants in individuals infected with multiple malaria parasites, leading to misclassification of trial results and impacting drug efficacy estimates.
In recent work, Dr. Juliano has considered the evolution of resistance to the standard artemisinin combination therapies (ACTs). His collaborates with Dr. Jessica Lin (UNC ID faculty) and researchers in Cambodia to develop an understanding of the evolution of resistance to ACT regimens. Dr. Juliano conducted the first large scale molecular survey in Africa to determine whether mutations associated with artemisinin resistance exist in the population, describing African parasite strains that clear more slowly after treatment with ACT, similar to hallmarks of artemisinin resistance in Southeast Asia. In collaboration with local researchers, he is exploring the clinical importance of these strains in an ongoing, longitudinal cohort study in Tanzania and Kenya.
Dr. Juliano’s interests include studies of other pathogens, including HIV, Pneumocystis jiroveci, Trypanosoma cruzi, and Acinetobacter baumannii. In partnership with Dr. Steven Meshnick at the UNC Gillings School of Global Public Health and other investigators on campus, Dr. Juliano helped form the Infectious Diseases, Epidemiology and Ecology Lab at University of North Carolina (IDEEL@UNC). IDEEL@UNC serves as a platform for collaborative, interdisciplinary research that generates new knowledge about the host-pathogen interaction and seeks to translate it into action. Investigators in IDEEL come from a wide breadth of backgrounds, including infectious diseases physicians, epidemiologists, molecular parasitologists, cell biologists, geneticists and geographers.
Lisa Hightow-Weidman, MD
Dr. Hightow-Weidman came to UNC in 2001 to begin a fellowship in the Division of Infectious Diseases, after completing her residency in internal medicine at Stanford University. Before that, she earned her medical degree from the University of Virginia. During her fellowship at UNC, Dr. Hightow-Weidman earned a master’s degree in public health in epidemiology from the Gillings School of Global Public Health. She has been on faculty at UNC since 2004, and is currently an Associate Professor in the Division of Infectious Diseases.
Dr. Hightow-Weidman is an expert on social media, and utilization and evaluation of technology-based interventions addressing the HIV Care Continuum for youth and young adults, particularly among young men who have sex with men (YMSM). Her research interests include HIV prevention for men who have sex with men (MSM) using both the Internet and other mobile technologies; interventions that use gaming and social networks to change behavior; biomedical HIV prevention technologies; and HIV diagnosis, linkage and retention in care for young MSM. She leads the Behavior and Technology or BAT Lab at UNC.
Dr. Hightow-Weidman was the recipient of a National Institutes of Health (NIH) K23 award to develop an Internet and mobile phone-based HIV/STI intervention for black MSM, known as HealthMpowerment. She also received an NIH R21 grant to develop a mobile phone application called AllyQuest, which uses social networking and gamification to engage HIV-positive young MSM with care. Dr. Hightow-Weidman’s work has also led to the development of a virtual reality-based intervention known as Tough Talks, which uses character-driven scenarios to provide users with training in disclosing their HIV status. She secured funding from the Health Resources Services Administration (HRSA) to fund a project aimed at developing successful interventions focused on engaging with Mexican MSM and transgender women.
Dr. Hightow-Weidman is currently working to establish the UNC/Emory Center for Innovative Technology (iTech). The center will impact the HIV epidemic by developing and evaluating innovative interdisciplinary research on technology-based interventions across the HIV prevention and care continuum for at-risk or infected youth aged 15-24 years in the United States. iTech will be the first center to use technology in scientifically rigorous and innovative ways to engage and impact at-risk or infected youth.
When not doing research, Dr. Hightow-Weidman manages the care of HIV-positive adolescents and adults at the UNC Infectious Diseases Clinic.
David van Duin, MD, PhD, FACP
Dr. van Duin is an Associate Professor of Medicine and the Director of the Immunocompromised Host Infectious Diseases Program in the Division of Infectious Diseases at the University of North Carolina. Dr. van Duin earned his medical degree from the University of Amsterdam in the Netherlands in 1999. He became interested in the study of infectious diseases during his internal medicine residency at Albert Einstein College of Medicine, where he worked on the role of melanization in fungi. He then went on to a post-doctoral fellowship in infectious diseases at Yale School of Medicine. At Yale, he was awarded a Doctor of Philosophy degree in investigative medicine in 2007 for his thesis work in the immunology of aging, with a specific focus on the impact of human aging on the function of toll-like receptors.
Prior to accepting a position at UNC, Dr. van Duin worked at the Cleveland Clinic. There, he was awarded the GEMSSTAR Award from the National Institute on Aging, as well as the 2012 Association of Specialty Professors-Infectious Diseases Society of America Young Investigator Award in Geriatrics. Seeing the devastating effects of infections with carbapenem-resistant Enterobacteriaceae (CRE) first-hand in his patients, he became interested in the issue of multi-drug resistance in Gram-negative bacteria. CRE are deemed an urgent threat – the highest threat level – by the Centers for Disease Control and Prevention (CDC). With support from the Clinical and Translational Science Collaborative, he set up the Consortium on resistance against carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE) in collaboration with Dr. Robert Bonomo from Case Western Reserve University.
The federally funded CRACKLE study has recently expanded to cover all five census regions of the continental US and currently includes 32 study sites with over 50 hospitals. The goals of CRACKLE are to describe the molecular epidemiology of CRE in the US and to provide insights how carbapenem resistance spreads within healthcare systems. In addition, results from CRACKLE will be used to guide clinical interventional therapeutic and diagnostic trial development in the area of CRE infections.
Dr. van Duin joined the Division of Infectious Diseases at UNC in June of 2013 to build the Immunocompromised Host Program. This program provides infectious diseases consultative services to those patients who are solid organ or stem cell transplant recipients, have hematologic malignancies, or have suffered burn injuries. In addition to a continued focus on Gram-negative resistance, Dr. van Duin’s research has also included clinical research into infections in these populations. For instance, with support from NCTraCS, Dr. van Duin is working with the surgeons of the North Carolina Jaycee Burn Center at UNC to describe the epidemiology and impact of infections in burn patients.