Dr. Diane Havlir: Beginning to End the AIDS Epidemic

reprinted from Issue 16, Spring 2013 of Frontiers of Medicine (PDF)

“In 2010, we were the first clinic in the world to offer treatment to persons at all stages of HIV disease to keep them healthy, knowing that it also had the secondary benefit of reducing HIV transmission. Thus far, results are encouraging.” – Diane Havlir, MD.

Think big, embrace debate, work as a team – these lessons have helped Diane Havlir, MD, become a visionary leader in the HIV/AIDS community.

Havlir (pronounced "HAVE-ler”), chief of the HIV/AIDS Division at San Francisco General Hospital (SFGH) since 2002, arrived at UCSF in 1984 as a resident. "As far as we knew, AIDS was a death sentence,” she says. "Yet many of us were very inspired by the courage of the patients and the determination of the community. What has really propelled progress against the AIDS epidemic is teamwork – the collective effort of the community, the medical profession and industry.”

Her own research has helped define the most effective treatments for patients with HIV/AIDS in the U.S., and has pioneered novel strategies in Africa for patients with overlapping diagnoses of HIV, malaria and tuberculosis. In addition to overseeing the world- renowned HIV clinic in SFGH’s Ward 86, Havlir also established domestic and international training programs in state- of-the-art HIV medicine.

"Dr. Havlir is leading tremendously important research projects, but as impressive is her mentorship in developing research careers for young faculty members,” says Paul Volberding, MD, director of the AIDS Research Institute at UCSF. "She has played a crucial role in developing the next generation of amazing talent at a challenging time, helping them find a research focus and protecting them from the distractions that are otherwise so hard to resist.”

Pioneering New Approaches

"There is an unprecedented sense of optimism in the HIV/AIDS community,” says Havlir. "A key reason is that using HIV treatments to reduce the amount of HIV in a person’s body also helps limit HIV spread in a community. In 2010, we were the first clinic in the world to offer treatment to persons at all stages of HIV disease to keep them healthy, knowing that it also had the secondary benefit of reducing HIV transmission. Thus far, results are encouraging.”

Havlir and her team are now about to measure the impact that widespread HIV therapy can have to curtail the epidemic in Africa. In 2010, she established the Sustainable East Africa Research in Community Health (SEARCH) collaboration with the World Bank, the National Institutes of Health and the governments of Uganda and Kenya. "We wanted to measure the magnitude of health, economic and education benefits for the individual, community and country if we provided HIV treatment for all those who are infected,” says Havlir. "Our study tests the hypothesis that in a community where HIV treatment is started early, health is preserved, adults stay in the workforce, kids stay in school, and over the long term, health care costs are less.”

The SEARCH study began this spring, and will offer annual HIV testing in 32 communities of 10,000 persons each. Intervention communities offer treatment to all HIV infected persons. Participants also receive bed nets, deworming for children, and screening and treatment for malaria, hypertension and diabetes. "SEARCH takes HIV out of a silo,” says Havlir. "This helps destigmatize HIV disease, and elevates care for other chronic health conditions. Communities are enthusiastically embracing this approach.”

Turning the Tide Together

Last July, Havlir served as the U.S. co-chair of the 19th International AIDS Conference, held in Washington, D.C. It was the first time the conference was held in the U.S. and followed President Obama’s lifting of the ban barring HIV+ people from entering the country. Nearly 24,000 people attended, and the theme was "Turning the Tide Together” – with an ambitious declaration co-authored by Havlir calling for an end to the AIDS epidemic.

A vital element of the conference was impassioned discussion on ending AIDS. "One of the strengths of the HIV community is that it embraces debate,” says Havlir. "By bringing varying viewpoints together, we have been able to develop consensus on important issues.... In HIV now, it’s all about the ‘how’: what is the best way to begin to end the AIDS epidemic?”

Havlir continues to teach and see patients, and is already beginning to catch glimpses of what a world without AIDS might look like. Recently, a 21-year-old patient called his HIV medicines his "old man pills.”

"I asked him, ‘What do you mean?’” recalls Havlir. "He said, ‘These pills are going to allow me to live to be an old man.’ That was a powerful moment. Our patients both inspire us, and make us think about new questions.”

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