'It's All Breaking New Ground'
As the directors of Tufts' Nutrition/Infection Unit, Drs. Christine Wanke, MD, and Sherwood Gorbach, MD, explore the link between nutrition and HIV/AIDS.
When you enter Sherwood Gorbach's office, the first things you notice are two wooden display cabinets filled with antique medicine bottles and various medical devices, which the professor began collecting in 1972, 10 years after graduating from Tufts School of Medicine.
The collection reflects his longtime interest in the medical field—an interest that has led him all over the world. While at Tufts, he spent summers in Mexico and Costa Rica, where he saw patients suffering from infectious diseases.
"Most of the deaths and illnesses I saw were related to conditions that were either treatable or preventable," he recalls. "So that interested me in this area. I've stayed with it."
Gorbach, who served as Chief of Infectious Diseases at Tufts-New England Medical Center from 1975 until 1989 and is currently a member of the Division of Geographic Medicine and Infectious Disease there, now co-directs the Tufts School of Medicine's Nutrition/Infection Unit. The group, formed in 1986 to study the ways nutrition influences the development and treatment of infectious diseases, is representative of the long history of international research into infectious disease at the school. That commitment dates back to Tufts' Dr. Louis Weinstein, who was the first Chief of Infectious Diseases at Tufts-NEMC.
Gorbach's current focus is on nutrition and the retrovirus HIV/AIDS. "AIDS, when it was first seen in Africa, was called 'the slim disease,' because everyone infected with it became very thin," he explains. "Historically, in Africa and in the United States, a major predictor of death in HIV infection has been weight loss, so we became interested in why people with HIV lost weight."
In 1994, Gorbach launched a 10-year study to explore that question. "What changed over that time was the introduction of treatment," he says. "But even when we moved on to multiple-drug regimens, about 30 percent of our patients continued to lose weight. And it still turns out that weight loss of greater than five percent over a six-month period is a predictor of when an [HIV-infected] person's going to die."
In addition to corroborating the relationship between weight loss and death in HIV-positive individuals, Gorbach's study explored the metabolic changes linked to HIV treatments. "Some of them were nutritional in origin," he says. "and some were related to what's called fat atrophy—where a person loses all the fat in their arms, legs and face—or on the other side, what's called fat deposition—where people develop large fat deposits, primarily in their abdomen."
Gorbach and his team were among the first to describe these nutritional syndromes, as well as to establish the relationship of these effects to HIV and its treatment and look into what could be done "to prevent, or at least ameliorate, them."
For the Nutrition/Infection Unit, that study and those findings were just the beginning. Under the leadership of Gorbach and Tufts Professor Christine Wanke, the unit is conducting multiple U.S.-based and international studies on issues of nutrition and HIV/AIDS, in locations such as South India, Vietnam, Thailand and Argentina.
"We're interested to know the impact of HIV on nutrition and metabolism on patients in those areas when they start getting antiretroviral therapy, which is just becoming available [to them]," says Wanke, who joined the Tufts faculty in 1998 specifically to work in Gorbach's unit and is also director of clinical HIV research in the Division of Geographic Medicine and Infectious Disease at Tufts-NEMC. Their work involves studying patients' eating habits, weight change, amount of muscle versus fat and HIV status both before and after antiretroviral therapy.
And they're constantly on the lookout for adverse effects of treatments, since some antiretroviral therapies can increase the risk of diabetes or heart disease—conditions which are common in South India regardless of HIV status.
"If we take a group of HIV-infected people and give them the wrong antiretroviral therapy, are we going to be complicating their medical condition even more?" Wanke says. "Is there a better antiretroviral therapy that they could be getting, one that would cause fewer complications? We hope to help optimize the introduction of antiretroviral therapy."
Anti-retroviral drugs at an international AIDS conference in Nairobi, Kenya, in September 2003.
For these reasons and many more, the study of HIV poses a unique set of challenges.
"HIV is a very complicated infectious disease—very different than many other infectious diseases we've dealt with before, because we can manage it, but we can't cure it," says Wanke.
For her, the study based in Chennai, South India, is of great personal interest, since it's taking place near the region where she first discovered her interest in international medicine. "I did my junior year of college [at the University of Wisconsin] in South India," the then-literature-and-language major remembers. "I had had no intention of going into anything medical or science-related, but that year showed me what the rest of the world is dealing with."
Wanke never looked back. When she arrived back in the U.S., she immediately changed her major to pre-med, eventually serving on Harvard's medical faculty after completing her M.D., residency and post-doctoral fellowship. "I worked on projects looking at diarrheal disease in children in Bangladesh, Thailand, Pakistan and Indonesia, and then started working in the late 1980s on HIV-related projects in Thailand," she says.
At Tufts, Wanke has had the opportunity to further explore HIV's impact in international populations—and as she's done so, the aims and methods of her research have evolved.
In certain areas, Gorbach says, those populations are largely comprised of drug abusers, so studies are designed accordingly. In Hanoi, Vietnam, intravenous drug use is examined as the likely major conduit for HIV transmission, while the Buenos Aires, Argentina, study focuses on both intravenous and snorted use of cocaine as a medium for HIV infection. One of the South Indian studies also focuses on HIV-positive drug abusers.
All three drug use studies, Gorbach says, "will be looking at nutritional issues. But in addition, we're also studying co-infections with tuberculosis and hepatitis and other risk factors for transmission. And at the site in Vietnam, we're looking at markers of resistance to anti-retroviral drugs."
Closer to home, Gorbach and Wanke are working with the National Institutes of Health's National Institute on Drug Abuse to launch a trial looking at the nutritional and metabolic status of HIV-infected drug users that will take place in Boston, Providence, the Bronx and Baltimore, which Gorbach calls "the first large-scale study of these issues in drug abusers."
That it is a field in which her work frequently has no precedent is part of what Wanke enjoys about the study of nutrition and HIV. "One of the exciting things about being involved in this whole area is that it's all breaking new ground," she says. "It's interacting with a lot of the old issues that we knew about, but it's putting them in new lights."
One thing that helps in all aspects of her group's work, Wanke adds, is the collaborative environment at Tufts. "People are very willing to participate in multidisciplinary projects so that we can expand out of infectious disease to looking at other complex issues," she says.
But even with all of this support and the strides she and Gorbach have made in their work so far, Wanke remains aware of the complexity of the problems they face.
"We're so privileged in this country—with the resources and expectations that we have—that it's important to me to remember that not everybody in the world is living with the same set of privileges," she explains. "We're certainly not walking in there thinking we have all the answers, but it's nice to be working to help understand what's going on and suggest interventions if we can."
Profile written by Patrice Taddonio, Class of 2006
Patrice Taddonio, a native of Holland, Pennsylvania, is an English major and a communications and media studies minor. Currently editor-in-chief of the Tufts Daily, she interned with the Improper Bostonian magazine during her sophomore year and worked as a temporary text editor with the Associated Press at the July 2004 Democratic National Convention. A songwriter, Taddonio has also performed on guitar and vocals at on-campus venues and at Boston-area benefits.
Gorbach and Wanke photos by Melody Ko, University Photographer. Middle photo by Simon Maina for AFP/Getty Images.
This story originally ran on Apr. 17, 2006.