Dr. Peter Gulick, D.O.
-osteopathic school in Chicago
-osteopathic principle: look at whole patient instead of specific symptoms, with emphasis on prevention
-internship in Detroit, became interested in oncology
-Cleveland clinic to study internal medicine first, then went to New York to work with leukemia, bone marrow transplants, etc.
-realized that most patients were dying from infections
-went back to Cleveland to study infectious disease
-began isolating T cells to study opportunistic infections, ended up being labeled as HIV
-came to Lansing for an academic path, became first provider in the area to care for HIV patients
-became depressing because HIV was not well-treated at that point
-new drugs in the 90s made the job easier, but nobody wanted to work with these patients
-the drugs also had a lot of adverse side effects
-learned a lot about the immune system in general by studying HIV
-largest provider of HIV care in Michigan
-research unit does translational research: merges principles of theory from scientists with clinical work
-average survival time for an AIDS patient has gone from 2 years in the 80s to about 40 years now
-also began working with Hepatitis C in 90s and still continues
-this virus is now curable, but is also the number one cause of liver transplant when patients are not diagnosed early
-works internationally with MSU COM’s clinic in Mexico and with a university in the Dominican Republic
-education for providers on HIV care
Current Drugs for HIV
-first drug developed: AZT, originally developed for oncology
-next drugs developed before really understanding the virus
-mid-90s: HART (highly active retroviral therapy) were used to work on reverse transcriptase and protease enzymes
-more sophisticated drugs developed with combination treatments to try to prevent the virus from replicating
-entry inhibitors: block CCR5 receptors so virus cannot enter the cells
-drugs now combined into one pill to take once a day to fulfill regimen
-but, this is not a cure: HIV can go into latency
-need to be careful which patients are treated to understand the disease on a more individual level
-prevention is being emphasized, especially in high-risk groups
-over a million cases of HIV in the US, with 25% undiagnosed who are responsible for the spread of the disease
-treatment is still very expensive
-Brian White grant provides money for patients without insurance
-preventive measures being taken in Africa through Bill Gates’ donation
-people born without CCR5 receptors were either immune or highly resistant to HIV
-some research does show increased risk for West Nile virus
-bone marrow transplant from one of these people provided one patient with complete absence of HIV in the body
-new research is looking into developing new vaccines to cause new cells to form without receptors
-research in cancer drugs is also becoming more specialized
-monoclonal antibodies are being used to directly affect specific receptors
-problem is that some patients become highly immunocomprimised
Cancer is not completely understood, because it has multiple dimensions:
-genetic element: risk increases with number of diagnosed relatives
-environmental: smoking, asbestos
-viruses: oncogenic types of HPV block suppressor genes, Hepatitis B virus causes liver cancer