SANTA FE – As a young, “terrified” gay man studying medicine in San Francisco in the early 1980s, Joel Gallant fled to the East Coast to avoid the AIDS epidemic.
“I did everything I could do to get away from the disease,” he said.
Almost three decades later, he’s a nationally – and even internationally – recognized leader in HIV/AIDS treatment and research, and is chair-elect of the HIV Medical Association.
And now he’s left the East Coast and a position as professor at Johns Hopkins University’s School of Medicine to practice medicine in Santa Fe at the Southwest Care Center.
In the arc of his career, he has seen HIV/AIDS transformed from a death sentence to a chronic, treatable disease.
The explanation for why he came to the City Different is a little easier than the one for how he became an expert in the disease that he originally shunned.
First of all, Gallant said, he’s a longtime friend of Dr. Trevor Hawkins, founder and medical director of Southwest Care. Gallant said he’s had a vacation home in Santa Fe for 20 years and loves the city. Also, any move upwards in the academic hierarchy would subject him to more administrative duties, something that he said doesn’t interest him.
And, with health care reform, academic research centers may have a harder time gaining recognition as federally qualified health care centers that could get higher Medicaid reimbursements for the expanding population under that federal program, he said.
“This is a concern nationally of people in academia,” Gallant said, explaining that they could lose a number of their patients and research subjects.
That won’t be an issue at Southwest Care, which also takes part in a broad range of research trials. “On my first day, I got put on 27 clinical trials – that’s more than I had at Johns Hopkins,” Gallant said.
So why did the guy who went to Johns Hopkins for a master’s in public health to study malaria end up in HIV/AIDS? He said if someone had predicted this career path then, he would have told them they were crazy.
But learning that he was HIV-negative helped calm his attitude toward the disease, he said. And then, after he was coaxed into helping in an HIV/AIDS clinic in Baltimore, “I realized this was the infectious disease of my lifetime.”
The early ’80s was a “devastating time” in the epidemic, Gallant said.
“There was so little you could do for people … even through the early ’90s.” The best doctors often could hope for was to give patients a relatively “good death,” he said.
“I found it very exciting from an intellectual viewpoint,” he said, noting that AIDS patients often developed “fascinating” complications or infections.
It was also emotionally “draining, exhausting and depressing,” Gallant said. “But it felt like you were doing something important.”
In 1996, though, with the advent of protease inhibitors and multidrug cocktails, HIV became treatable, he said. Still, some of the side effects were tough and some people’s infections became resistant to the drugs.
In 2007, new drugs came to the market that required fewer pills per day and reduced side effects, so “everyone was treatable,” Gallant said.
An unfortunate result is that people have slacked off on prevention, he said. Early on, people would vow, “I will never give this to anyone,” Gallant said, adding, “I don’t hear that any more.”
Work is proceeding on “pre-exposure prophylaxis” – basically, giving someone a couple of treatment drugs daily before they are infected, so that any early infection would quickly be killed. It may seem strange, but “(some) people are willing to take a pill every day, but are not willing to use condoms,” he said.
And now people are talking about a cure.
“Through most of my career, that would have been a pipe dream,” Gallant said. “Now that’s different.”
HIV drugs work on the virus as it is multiplying. The barrier to a cure is that the virus also exists in long-lived latent cells, which are not dividing and are hard to target, he said.
One idea for a cure has been to find a way to activate all of the cells so that they are dividing and susceptible to current treatments, Gallant said, but it’s hard to believe that there wouldn’t still be some infected, latent cells left behind.
Another approach comes from the recent discovery that an infected person who received a bone marrow transplant appeared to have no remaining HIV infection afterward. Researchers are looking at a safer variation on that: removing infected CD4 cells from a person’s blood, sending them to San Francisco to be genetically modified to eliminate a crucial co-receptor on the cell’s wall and reinfusing those cells into the person’s body.
“Studies show the effect (of HIV resistance) seems to persist in some patients,” Gallant said, adding that Southwest Care is participating in this trial.
Still, he cautioned, it’s likely a cure “is a long way off.”