February 18, 2014 — When people who have been cured of tuberculosis (TB) re-develop the disease, are they relapsing or fighting a new strain? How often should HIV/AIDS patients be tested to see if antiretroviral treatment is working?
These questions are being explored by doctoral candidates Ellen “Ellie” Caniglia and Richa Gawande who are conducting infectious disease studies at Harvard School of Public Health (HSPH). For both Caniglia and Gawande, the scientific explorations reflect their desire to find answers to urgent public health questions that they hope will lead to new ways to treat and prevent infectious diseases, especially those impacting impoverished countries.
“Infectious diseases disproportionately affect developing nations. I’ve always been drawn to work on problems that impact poor populations,” said Gawande, who has seen firsthand the problems of global health inequities during travels to India and Haiti. “I want to be part of the collective effort to understand, treat, and prevent disease,” she said. Her interests ultimately led Gawande to HSPH where she is enrolled in the Ph.D. Program in the Biological Sciences in Public Health and works in the laboratory of [[Sarah Fortune]], Melvin J. and Geraldine L. Glimcher Associate Professor of Immunology and Infectious Diseases.
Gawande is investigating why about 10% of confirmed TB cases worldwide are in people who were successfully treated. She is analyzing sputum samples from South African TB patients to determine the origins of their recurrent disease. The study is among the first to look at TB recurrence by using whole genome sequencing, and the first study of its kind in an HIV-positive population. “It is especially rewarding to collaborate with South African clinicians and know that the study findings will make a difference in the treatment of their patients,” she said.
A college course using math models to study infectious diseases, a sociology course on AIDS, and volunteer work at a Philadelphia AIDS organization all spurred Caniglia to enter the field of infectious disease epidemiology. At HSPH, she conducts HIV/AIDS research under the direction of [[Miguel Hernan]], professor of epidemiology. “While the introduction of highly active antiretroviral therapy has changed the course of the epidemic, the stigma surrounding the disease and discrepancies in treatment and care persist,” she said.
Caniglia and her colleagues are exploring the question of when HIV/AIDS patients taking antiretroviral drugs should have certain blood tests. A declining number of T-lymphocytes expressing CD4 cells is an important marker of HIV progression, yet how often patients should be tested for this marker is unclear. “This study aims to answer a very important question and has the potential to inform clinical practice,” Caniglia said. “There is still a lot of work to be done, and I am excited to have the opportunity to be a part of it.”
Jonathan Freeman Symposium
Caniglia and Gawande were among 18 HSPH students, post-docs, and faculty who presented research at the 12th Annual Jonathan Freeman Symposium on the Epidemiology of Infectious Disease in December 2013 at the School.
The symposium honors the memory of the late HSPH faculty member Jonathan Freeman and his contributions to the Infectious Disease Epidemiology Program. Freeman was a faculty member in HSPH’s Department of Epidemiology from 1990 until his death in 2000. He was instrumental in creating and leading HSPH’s inter-disciplinary concentration in infectious diseases.
photo: Aubrey Calo