An oncologist turned HIV expert takes on another role

It’s true. My training was in medical oncology. But, let me explain how it is that I’m proud to have accepted the offer to become the new Chief Medical Editor of Infectious Disease News.

I fell in love with virology as a college student and pursued the science throughout my medical training. My college mentor at the University of Chicago was Mark Beem, who studied pediatric respiratory viruses; my medical school mentor at Minnesota was Charles Moldow, and in his lab, I first met retroviruses — the subject of my career for the past 30 years.

During my fellowship at the University of California, San Francisco, I worked in another retrovirus lab, Jay Levy’s, later one of the co-discoverers of HIV. At the end of my fellowship, I was offered the challenge to start a division in medical oncology at San Francisco General Hospital by the newly arrived Medicine Chief, Merle Sande. The rest is, in a real sense, history.

On my first day, July 1, 1981, I saw the first Kaposi’s sarcoma patient admitted to SFGH, and thus, an introduction to two unknown viruses, HIV and HHV8. My early career focused on AIDS cancers while my close colleague, Connie Wofsy, addressed the opportunistic infections. Together, we founded the world’s first and still widely recognized AIDS clinic and worked with Merle, who, together with Cliff Morrison and other SFGH nurses, opened the first inpatient AIDS ward.

With the discovery of HIV between 1983 and 1984 and the testing of azidothymidine (AZT) and early reverse transcriptase inhibitors, my own career rapidly pivoted back to virology as I participated in clinical trials to better control HIV replication. Along the way, while my love of oncology continued, I could hardly avoid a close connection to the amazing scope and challenge of HIV-associated infections.

Infectious disease community

Although that expertise has now atrophied, we well recall the days of knowing in our pores the doses, schedules and complexities of toxoplasmosis, cryptococcal meningitis, pneumocystis and all other infections that maimed and killed nearly everyone for whom we cared. I was accepted in the infectious disease community as a result, becoming a Fellow of the IDSA (Merle said they lowered the bar, but my welcome seemed genuine) and helped found the HIV Medicine Association within the IDSA — a story I may tell at a later point.

Just more than 10 years ago, I accepted the offer to move to the San Francisco Veterans Affairs Medical Center as the Chief of Medicine. I joked at the time with my residents that I knew a lot about a few cancers (primarily Kaposi’s sarcoma and lymphoma) and one infection (HIV), but little else. My career may prove that lifelong learning really is possible. I’ve learned a good deal of internal medicine at the feet of real giants at the Veterans Affairs Clinic, although they would endorse my very long learning trajectory and the considerable distance I yet have to travel. Among my learning has been the broader body of infectious disease that is directly associated with HIV infection and its masqueraders. One of our favorite cases — a lumbar tophi presenting and misdiagnosed as a paraspinal abscess.

Continuing the pathway

I have had the distinct pleasure of serving on the Infectious Disease News Editorial Board for a number of years and have helped, along with others, in guiding the expansion of the publication in HIV and other infections. Ted Eickhoff has been an inspirational leader in this effort, and his success and the great and enduring staff support make it possible to begin to imagine continuing Ted’s pathway in creating in the newspaper a means of sharing the incredible progress and excitement that has been so evident recently in infectious diseases.

We are gaining new tools in some infections while still facing a dearth of new treatments in others. New diagnostics in tuberculosis are potential game-changers, even in resource-limited settings, and vaccine progress in human papillomavirus may once again underline the intimate (literally in this case) relationship between infections and cancers and allow control of cervical cancer — one of the most common fatal cancers in many regions and the growing burden of oral cancers here in the United States. Antiviral drug development, (following on the success in HIV) offers optimism and potent new molecular assays and will increasingly allow the almost immediate identification of emerging pathogens.

The science of infectious diseases will represent an ongoing “story line” for Infectious Disease News, but the practical context of this in an era of dramatic shifts in medical education, financing and delivery will definitely not be ignored. The cognitive specialties of medicine need urgent attention if they are to survive and continue to attract the next generations of physicians. We have to question the logic that allows a higher compensation for a routine automated lab test than for the careful consideration of the highly trained professional who ordered the test and interprets and applies the results to save patient lives.

I look forward to assuming the leadership of Infectious Disease News and do so with an appreciation that I have been given an already highly effective publication and the support of a professional staff and dedicated Editorial Board. And now, if I occasionally suggest connections between infections and cancers, you may know why.

A trusted colleague

It gives me particular pleasure to welcome the new Chief Medical Editor of Infectious Disease News — Paul A. Volberding, MD. Paul has been a member of the Editorial Board for about 6 years and was quickly recognized for his thoughtful comments, ideas and suggestions.

Paul is an extraordinarily accomplished physician and researcher. Readers who attended Paul’s Kass Lecture at the 2009 IDSA meeting in Philadelphia will surely recall the documentary film that he created and presented. Life Before the Lifeboat vividly portrayed the suffering, the anguish and the small triumphs of the early years of the AIDS pandemic in San Francisco, from 1981 to the advent of the HAART era in 1995. It was an extraordinarily emotional event that concluded with a prolonged standing ovation. There was scarcely a dry eye in the house.

Paul is not an infectious disease-trained physician; he is an oncologist and is sensitive to this issue. However, the experience he has had during 30 years of studying and caring for AIDS patients could not have been provided in any ID training program in the country. Furthermore, he will have an Editorial Board composed primarily of infectious disease physicians. One of the major reasons I am so delighted to welcome Paul to the Infectious Disease News editorship is my firm belief that the most exciting advances in infectious disease in the next decade will be in the prevention and treatment of HIV infection.

Paul is wonderfully wise and perceptive — yet quite modest. Infectious Disease News is indeed fortunate to have Paul Volberding take the helm.

- Theodore C. Eickhoff, MD, is Editor Emeritus of Infectious Disease News.