A Conversation with Michael S. Saag, MD

Issue: February 2015

In this issue, HCV Next asks five questions of Michael S. Saag, MD, professor of medicine, Jim Straley Chair in AIDS Research and director of the Center for AIDS Research at the University of Alabama at Birmingham. Saag is also the Co-chief Medical Editor of HCV Next.

Michael S. Saag

Saag attended college at Tulane University in New Orleans, where he received his Bachelor of Science in chemistry in 1977. From there, he went on to the University of Louisville for his medical degree, and then to the University of Alabama at Birmingham for his residency and fellowship training in infectious diseases and molecular virology. His fellowship was marked by a seminal paper on the genetics of HIV, which was published in Nature in 1988. He also published a paper in The New England Journal of Medicine in 1992 that demonstrated the utility of azole therapy in patients with HIV and cryptococcal meningitis, and he went on to turn the AIDS Center at University of Alabama at Birmingham into a hub of research activity.

Saag has received several awards, including the Outstanding Medical Research Award from the AIDS Task Force of Alabama, and Science cited him as one of the top 10 HIV researchers in 1996. In addition, he has served on the NIH Office of AIDS Research Advisory Council and is president-elect of the HIV Medical Association. To date, he has published more than 350 articles in peer-reviewed journals.

Today, his topics of professional interest include HIV, hepatitis C virus, hepatitis B virus and general infectious diseases. Recently, Saag wrote his first book, Positive, a memoir that traces his professional and personal experiences as an international expert on HIV.

What was the defining moment that led to your field?

During my first week as a fellow in infectious diseases, I saw a woman in clinic who was referred to us to determine whether she was infected with HIV. The Red Cross had just started testing all blood donors for HIV in May 1985, and she was informed in June that she was infected. The diagnosis did not make sense: She had no risk factors, no symptoms and no reason to be infected. Working with George M. Shaw, MD, PhD, we determined that she had a false-positive Western blot. This led to a paper in NEJM and a long-standing collaboration with Dr. Shaw and Beatrice H. Hahn, MD. The experience introduced me to academic medicine, translational research, and the world of HIV and virology.

What area of research in hepatology most interests you right now, and why?

While drug development and discovery still engender a high degree of interest, my most pressing interest in hepatitis research is the area of cost-effectiveness and public policy. With so many highly effective drugs emerging on the market within a short period of time, we find ourselves limited by the cost of the medicines and the relative barriers created within health systems trying to carve out funding to pay for the medications. Understanding the true cost-effectiveness of each regimen and using those data to create market forces to lower the costs and improve access is a key need right now into which I plan to engage.

What advice would you offer a student in medical school today?

Find your passion and seek a career that fulfills your aspirations and dreams. Don’t think too much about pathways to success. Rather, feel the opportunities and go with your gut instincts; they are almost always right.

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

I have been very fortunate in this regard. I was in the cat-bird seat as all of the new antiretroviral drugs were released and was able to apply new technologies, such as HIV viral load, to help speed the development of the new drugs. Our team was also able to quantify viral dynamics in HIV, generating an understanding of HIV pathogenesis that suggested everyone should be treated as soon as possible.

What’s up next for you?

Taking as many of the lessons learned during the HIV antiretroviral therapy revolution of the 1990s and applying it to the rapidly emerging revolution in HCV therapeutics. The similarities between the two are striking and the knowledge garnered during the HIV experience has direct application to HCV.