HIV Infection

Clinical Strengths

The RUMC and CCH Division of Infectious Diseases has numerous faculty with clinical experience in HIV infection. This includes expertise in HIV and microbiome (Dr. Brett Williams), HIV prevention (Drs. Shivanjali Shankaran, Gregory Huhn, Temitope Oyedele, Audrey French, Monica Mercon, Sybil Hosek, Beverly Sha), HIV and hepatitis (Drs. Monica Mercon, Gregory Huhn), HIV and women (Drs. Beverly Sha, Mariam Aziz, Audrey French), HIV and children (Dr. Mariam Aziz), HIV and adolescents (Dr. Temitope Oyedele), HIV and correctional healthcare (Dr. Chad Zawitz), HIV and sexually transmitted infections (Dr. Sabrina Kendrick, Homer Abiad), HIV Care Continuum (Dr. Ronald Lubelchek, Dr. Gregory Huhn), HIV and Substance Use Disorders (Dr. Pam Vergara-Rodriguez), and HIV-related comorbidities (Drs. Sheila Badri, Gregory Huhn, Audrey French, Beverly Sha, Mariam Aziz, Shivanjali Shankaran, Brett Williams).

Inpatient services:

• CCH HIV Service. Trainees manage complications of HIV infection and opportunistic infections on an HIV consult service at Stroger hospital. They supervise a multidisciplinary team of housestaff, pharmacists, physician assistants and social workers to provide state-of-the-art care to this complex patient population.

Outpatient services:

• The Ruth M. Rothstein CORE Center is the principal public safety net HIV clinic in the Chicago metropolitan area. The CORE Center serves one-third of the HIV patients and the majority of the women with HIV, which is about 5000 unduplicated HIV infected patients. ID fellows have their continuity clinics housed here.
• The CORE Center provides single-site comprehensive care including primary medical care, psychiatry, dentistry, dermatology, hepatitis, nephrology, neurology, nutrition, obstetrics and gynecology, pediatrics, hematology-oncology and chemotherapy, mental health, psychosocial support, substance abuse counseling, pharmacy, and medical case management. CORE Center has a prevention department that works within the community to test our target population and offers PrEP (pre-exposure prophylaxis) services for patients.
• The Mark Weiss Memorial Clinic for Infectious Diseases at RUMC has a census of approximately 700 HIV-infected individuals. Trainees participate in the care of these patients on their outpatient rotations.

Research Excellence

Research in HIV is robust in numerous areas and includes:

NIH-sponsored Clinical Trials:

• The Division of Microbiology and Infectious Diseases STI Clinical Trials Network, led by Dr. Audrey French at the CORE Center, explores novel diagnostic and treatment strategies for sexually transmitted infections.
• Dr. Pam Vergara-Rodriguez leads the National Institute of Drug Abuse Clinical Trials Network at the CORE Center, exploring strategies to optimize HIV care and delivery to HIV-infected substance abusers.
• RUSH is a site for the HOPE in Action Multicenter Kidney Study evaluating kidney transplantation between people with HIV (Dr. Carlos Santos, Principle Investigator; Drs. Yoona Rhee and Shivanjali Shankaran, Co-Investigators)
• RUSH and the CORE Center sub-site participate in The International Maternal Pediatric AIDS Clinical Trials Group (IMPACCT) led by Dr. Mariam Aziz. IMPAACT explores optimal dosing and therapy for pregnant women and children with HIV, the impact of HIV and HIV therapy of children with and exposed to HIV, as well as vaccine trials in healthy uninfected children.

The CORE Center was a leading site for recruitment under the direction of Dr. Oyedele for the HPTN 083 study examining long acting cabotegravir for HIV prevention. Both RUSH and the CORE Center are now active sites for the NIH Coronavirus Prevention Network (CoVPN), devoted to COVID-19 prevention. 

Pharmaceutical Trials:

• Drs. Greg Huhn, Toyin Adeyemi, Ron Lubelchek and Beverly Sha lead clinical trials of novel agents and delivery methods for HIV, novel agents for hepatitis C treatment, and novel vaccine strategies.

Observational Studies:

• The CORE Center is the lead institution for the Chicago Women’s Interagency HIV Study (WIHS) now part of the MACS/WIHS Combined Cohort Study and is led by Drs. Audrey French and Mardge Cohen. It is a longitudinal study of HIV-infected and demographically similar uninfected women ongoing since 1994. Dr. French, with Helen Burgess from RUMC, has a WIHS-nested R01 exploring the interaction of HIV, Sleep and Circadian Disruption and Cardiometabolic Outcomes. Dr. Brett Williams has also collaborated with the Women’s Interagency HIV Study (WIHS) cohort to investigate the gut microbiome in women with HIV. RUSH is a sub-site of the Chicago WIHS under the direction of Dr. Beverly Sha. 
• The CORE Center also houses a sub-site of the Multicenter AIDS Cohort Study (MACS) led by Dr. Sheila Badri. The MACS is a longitudinal study of HIV-infected and uninfected MSMs which began in 1983.

HIV Prevention:

• The CORE Center has particular strength in HIV prevention among young and very young MSM and other sexual minority persons of color. The CORE Center’s Dr. Sybil Hosek led the Adolescent Trials Network (ATN) 113 study which led to the FDA approval of Truvada-based PrEP for at-risk persons less than 18 years old. Dr. Greg Huhn’s ATEAM R01 explored the effect of an embedded digital adherence sensor on PrEP usage. PrEP clinical trials at the CORE Center include HPTN 083, injectable cabotegravir PrEP, and lenacapavir (led by Drs. Hosek and Temitope Oyedele) and the Discover trial of tenofovir alafenamide/emtricitabine for PrEP. A number of initiatives using technology to increase PrEP uptake and usage are ongoing. Drs. Shivanjali Shankaran and Beverly Sha via a pilot program are evaluating PrEP using a RUSH EPIC EMR algorithm to find women at risk of HIV infection to approach about PrEP.

HIV and Malignancy:

• The CORE Center houses the only Chicago site of the AIDS Malignancy Consortium (AMC), led by Dr. Paul Rubinstein. The AMC runs clinical trials of novel agents for AIDS-defining and AIDS-related malignancies.

Test and Treat: 

• RUSH is a Gilead FOCUS site. FOCUS funding supports HIV, HCV and HBV screening and linkage to the first medical appointment after initial diagnosis. 
• Additionally, RUSH is part of the Expanded HIV Testing for Disproportionately Affected Populations in Healthcare Settings in Chicago Project with the University of Chicago for the Chicago Department of Health. To increase HIV and HCV screening per national guidelines, Drs. Beverly Sha and Shivanjali Shankaran have created EMR based HIV and HCV screening alerts on the ambulatory side and automated screening in the RUSH University Medical Center and RUSH Oak Park Hospital Emergency Departments. We have created a system for Infectious Diseases and Hepatology to reach out to patients who test positive and link them to care. 

HIV Care Continuum: Dr. Ron Lubelchek has led an integrated care initiative among a network of several major healthcare institutions throughout Chicago to capture through an electronic surveillance system persons living with HIV who have been out of care to link them back into primary care. 

Basic Science: We collaborate with basic scientists at RUSH particularly the Department of Microbial Pathogens and Immunity to study HIV longterm non progressors.

• Dr. Hemil Gonzalez is studying the effect of newer combinations of combination antiretroviral therapy on astrocytes and monocyte-derived macrophages. He is funded through and R21 grant titled cART effects on glial cells (1R21MH122241-01) under the direction of Dr. Lena Al-Harthi, Professor and Chair of Department of Microbial Pathogens and Immunity. 

Other Opportunities

Cook County Jail is one of the largest single-site correctional facilities in the United States. Cermak Health Services provides comprehensive infectious diseases care to a population of six to ten-thousand detainees on any given day. Approximately 2% are living with HIV, with 17%  living with Hepatitis C. ID fellows can choose to spend time with the Medical Special Care Unit, Opiate/Detox programs, Urgent Care, and other correctional clinical settings. In addition, there are several opportunities for clinical, public health, and epidemiologic research at the Cook County Jail. Prior and current research has included HIV, MRSA, STI, community linkage/continuity of care, partners of prisoners, and young black MSM. Additional research with behavioral health, addiction, and women’s health are ongoing.