| p:
415-206-6078
f: 415-206-8965
e: jcritchfield@medsfgh.ucsf.edu
San
Francisco General Hospital
1001 Potrero Avenue
Room 5H22
San Francisco, CA 94143
Dr.
Critchfield received his M.D. (1994) from the University of California,
San Francisco. After completing a residency in Internal Medicine
(1996) at UCSF he served as Chief Medical Resident (1997-98) then
subsequently completed a Rheumatology fellowship (1999). In 2001
he joined the clinical faculty at San Francisco General Hospital.
His major academic activities include administering the clinical
operations of the inpatient medical service at SFGH, participating
in the training of UCSF house-officers and medical students, and
pursuing clinical research on the impact of HIV associated immuno-pathology.
Research Interests
Advanced HIV disease poses an intriguing paradox. Loss of CD4 T cells, the hallmark of AIDS, suggests that infected individuals are immunosuppressed, yet careful characterization of lymphocytes in these patients indicates that the extant T cells are dramatically activated. For example in an untreated HIV infected patient, though their CD4 count might be 175, 40% of their CD4 cells and 60% of their CD8 cells are activated. By our best means of detection, there is no evidence to support that the majority of this immuno-activation is HIV specific. Thus HIV infected patients, though quantitatively immunosuprressed may be experiencing dysregulated, non-antigen specific activation of what remains of their immune system. Several groups have reported that the degree of this immunoactivation is the single best indicator for advance of AIDS with direct correlation between T cell loss and T cell activation.
Through collaborations with HIV clinicians maintaining a large, well characterized prospective cohort of HIV infected subjects at varying stage of disease and treatment; and human immunologists investigating the means by which HIV disrupts immune regulatory mechanisms, we are seeking to understand what role T cell activation plays in the loss of T cells. We are pursuing two strategies: observational work based on the rich resource of clinical, laboratory and stored cells provided by the cohort; interventional studies designed to pharmacologically immunosuppress HIV infected patients to determine what impact this plays on T cell loss.
Current Interventional Study
Effect of Atorvastatin on T cell activation in HIV Disease: The degree of T cell activation is closely correlated with progression of HIV. This pilot study is designed to answer the question: Can the immunomodulatory effects of atorvastatin decrease either macrophage/monocyte activation or T cell activation in subjects with HIV. If data are promising, a larger follow-up study will be performed, powered to determine if this atorvastatin induced immunosuppression yields benefits to re-constitution of T cells in patients with HIV disease.
Relevant Publications
Critchfield, J.M., Deeks S. Treating the latent reservoir. AIDS Read 14(9) 485. 2004
Hernandez G, Critchfield J, Rodriquez R. Interpretation of positive serologies for autoantibodies in an HIV-infected patient with kidney disease. In preparation.
Chapters
Critchfield JM., Newman M. Approach to arthritis in patient with AIDS. in Current Medical Diagnosis and Treatment: Rheumatology. 1st Edition. Lange. 2004.
Critchfield, J.M. Signs, Symptoms, and Laboratory Abnormalities in Rheumatology. Hospital Medicine, 2 nd Edition. eds. Goldman, L., Wachter, B.W., Hollander, H. Lippincott 2005.
Critchfield, J.M., Williams M. Care of the socially complicated inpatient. Vulnerable and Underserved Populations: Principles, practices and Populations. eds Wheeler M. et al. McGraw Hill. In press. |
