A Few Steps Ahead

Carlos del Rio first came to Emory as a budding cardiologist in the early 1980s. Then the AIDS epidemic hit.

By Dana Sand 14C

Carlos del Rio

For decades, Hubert Chair and Professor of Global Health Carlos del Rio has worked to combat the spread of HIV in Atlanta and around the world.

Bryan Meltz.

As Carlos del Rio boards the plane back to Atlanta from Puerto Rico and settles in his seat, a flight attendant approaches him. “We appreciate what you do for us. Thanks for your business. You keep us employed,” the flight attendant says, shaking his hand. It’s May 2, and Del Rio has already traveled 120,000 miles since January. 

“I’ve gone three times around the world between January and now. When you reach that on a plane, you’ve been there way too much,” he says with a laugh. The chair of Emory’s Hubert Department of Global Health, Del Rio is always on the move. 

“Two weeks ago I was in San Francisco, last week I was in Vancouver, this week I was in Puerto Rico, next week I’m in Denver, the following week I’m in Cancun, and the following week I’m in D.C.,” he says. “For international trips, I’ll be going to Georgia in June and Africa in July. I tend to find time in the summer to do the two- or three-week- long trips I need to do for work.” 

Del Rio always returns to fulfill his many roles here at Emory as a researcher, clinician, professor, administrator, and mentor. Every Monday, he meets with his 15-person research team at Grady Memorial Hospital. As he brings up his fully color-blocked schedule on the computer in his office, he describes it as “nonstop and always full of excitement.”

According to Del Rio, who also holds a position as co-director for the Clinical Science and International Research Core of the Emory Center for AIDS Research, about 60 percent of this time is dedicated to his research agenda. He has been studying and collaborating with several faculty members at Emory on HIV/AIDS since his arrival in 1984.

Along with his many domestic studies, Del Rio also has been involved with a number of international research pursuits. In Mexico, he has been working with investigators at the National Institute of Public Health to understand the impact of immigration to the US on the HIV epidemic. In the Republic of Georgia, he has been working for more than 15 years in collaboration with Henry Blumberg studying HIV, tuberculosis, and hepatitis C. Georgia is a country that has a concentrated HIV epidemic, with most cases currently occurring among injection drug users. Thus, there is an opportunity to control the epidemic and prevent it from becoming generalized, as has happened in neighboring Ukraine. According to Del Rio, TB is also a major problem in Georgia like it is in many of the former Soviet Republics, and there is an increasing number of cases of multi-drug-resistant (MDR) and extensively-drug-resistant (XDR) TB, which is resistant to some of the most effective anti-TB drugs. In all of these studies, he describes the greatest challenge as “taking research to implementation and policy and practice at all levels.”

Having recently completed two three-year-long studies—HIV Prevention Trials Network (HPTN) 064, or the ISIS study, on women affected by HIV, and HPTN 061 on black men who have sex with men (MSM)—the research team is now in the analysis and presentation stage. For the ISIS study, about 400 women in low-income, high-HIV rate areas in DeKalb and Fulton counties were recruited and observed for one year with a six-month follow-up, and the results were presented at the Retrovirus Conference this February.

“Those are preparatory studies for potentially doing a prevention study here in Atlanta,” says Jeffrey Lennox, who is a principal investigator at Emory’s HIV/AIDS Clinical Trials Unit at the Ponce de Leon Center and a professor at the Emory School of Medicine. “There’s been a set of—during the last 10 years that we’ve been working together—dozens of studies that we’ve been local principal investigators here and some of them that we’ve worked on at the national level as study team members to help actually write the study, get it through all the regulatory hurdles, get all the approvals at the sites, and then do the study and analyze and publish the results.”

In the meantime, Del Rio is starting two new studies as principal investigator. One is CTN 049, the National Institute on Drug Abuse-funded Project Hope study, looking at HIV-infected drug users that are not in HIV care and how to link them to and retain them in care.

“One of my areas of interest has always been why, despite free access to medications and clinical care in the US, we have a large population of people who are not in care,” Del Rio says. “The CDC says there are about a million HIV-infected individuals in the United States. About 20 percent don’t know they’re infected, and at the end of the day only about 20 percent of people with HIV in the country are doing well from a clinical standpoint.”

Along with Project Hope, the second study is also designed to find ways to solve this dilemma. Through Project Retain, an NIH-funded study, Del Rio’s research team hopes to study those who were linked to care but were lost, and to find ways to bring them back to care.

Research Project Coordinator Valarie Hunter says the research team is looking at patients currently hospitalized in Grady Hospital who have substance-abuse issues with alcohol or some type of narcotic.

“We’re trying to see if patient navigation with contingency management will help them stay clean and lower their viral load,” Hunter says.

After enrolling about 80 patients by the end of June, the three-arm study likely will take approximately four to five years to reach completion. Each patient will be randomly assigned to one of the arms.

Chris Root, who worked on the HPTN studies and is now involved in Project Hope and Project Retain, says the study is “looking at those three arms and figuring out which is the best strategy to re-engage HIV-positive substance abusers into care, with the ultimate end goal of biologic depression.”

For Project Hope, Emory is one of 10 sites nationally participating in the study. The Project Retain study, which will activate after Project Hope, is partnered with the University of Miami and will enroll about 260 patients.

As a co-researcher, Lennox describes Del Rio as very creative and quick on his feet. “He thinks several steps ahead, sort of like a chess player,” he says. “He comes up with an idea, then he builds on it and moves forward and can see what the barriers are and plans ahead on how to overcome them.”

Carlos Del Rio

Carlos del Rio talks with Richard Hubert of the Hubert Foundation.

Bryan Meltz

With a dozen AIDS Clinical Care binders lining one shelf in his office bookcase and studies on HIV/AIDS both domestically and abroad, it may seem like HIV/AIDS consumes Del Rio’s life—though he makes time to be on the Atlanta Symphony board and attends 10 Braves games a year.

This wasn’t always his plan. He began his Emory residency in 1984 because of world-renowned cardiologist Willis Hurst. 

“When I came to Emory as a budding cardiologist, I ended up doing HIV and infectious disease just because the epidemic was starting as I was starting my training. It was a little bit of seeing the train from the very beginning,” Del Rio says.

Although HIV/AIDS research had not always been on his agenda, global health had been. Having been born and raised in Mexico, where he also served as the executive director of the National AIDS Council of Mexico in the 1990s, Del Rio explains that he always looked at the differences between people who had access to health care, vaccines, and clean water, and those who did not.

“I think a little bit of it is a sense of wanting to do my little contribution to equity. Bill Gates does it with his billions, and I do it with my brain,” he says. “I love the motto of the Gates Foundation—that everyone is entitled to live a healthy, productive life. I couldn’t agree with that more. In this world where there are so many resources, why do children need to die of malnutrition or unsafe water or lack of receiving an immunization that costs pennies?”

It only makes sense, then, that his interest in global health led him to the HIV/AIDS epidemic, which he describes as the epitome of what a global disease is. In his several years of studying the disease, Del Rio believes the response to HIV has been unlike the response to any other disease.

“HIV transformed the involvement of people living with HIV, of civil society, of researchers, and the commitment of the UN General Assembly,” he says. “We can really do something to change the course of this epidemic, and to be part of that is exciting.”

Wendy Armstrong, medical director for the infectious disease program at Emory and co-investigator for Project Hope and Project Retain, has worked with Del Rio for four-and-a-half years on HIV/AIDS projects and says one of the unique things about him is that he often sees issues earlier than others—while these issues are hot topics now, he has been working on them for years.

However, what she emphasizes most about working with him is not his extensive publications or involvement in AIDS research, but the breadth of the contributions he has made to the Emory community.

“One of the cool things about him is that he takes pride and feels it’s part of his mission to mentor people who are not as far along in their careers—so that could be me, as a colleague, or it could be our infectious disease fellows in training or residents or students,” Armstrong says. “There are examples of individuals that he has helped at every single level of education and at every single level in their career, from very junior to very senior.”

As the Infectious Diseases Fellowship Training Program director, Armstrong says Del Rio has mentored many of the fellows, such as Krutika Kuppalli, who is looking at the HIV/AIDS epidemic in Indian women and how their marital status affects their likelihood or ability to adhere to antiretroviral therapy, and Sophia Hussen, who is studying the role of “expert patients” in antiretroviral adherence in Ethiopia.

Root also can attest to this firsthand. After having five knee surgeries, she wanted to challenge her strength, so she signed up for the 550-mile Heartland AIDS bike ride in 2001. One of the beneficiaries was the Emory Vaccine Center, and by chance, Root met Del Rio and several other Emory researchers. She began volunteering part-time in her hometown in Wisconsin, counseling and testing for HIV and hepatitis C out of a mobile van for three-and-a-half years. Having worked 15 years in retail management, she decided it was time for a change and left her job to work on HIV/AIDS research at Emory.

“I think for someone like me to try to learn a new career in the field of research, there couldn’t be anyone better to work under. He’s really given me the opportunity to learn and grow in my position,” Root says. “He’s not only a world-renowned researcher, but I think what’s most impressive about him is that he is an advocate for the HIV-positive community, for his staff, for the School of Public Health, and for Emory as a whole.”

Venkat Narayan, a professor in the Department of Global Health, also points to collaboration as one of Del Rio’s many strengths, referencing a paper the two recently co-authored for the New England Journal of Medicine.

“The article was about what noncommunicable diseases can learn from HIV/AIDS through an interactive approach,” Narayan explains. “It was a good example of great collaboration—neither of us could have written that paper alone, but together we were able to write a fantastic paper.”

For his part, Del Rio believes that collaboration and passion are two key ingredients to success in global health. “I think it’s really important for people to realize that change takes time and you need to be persistent. You need to realize that rarely can you change the world alone; you need to work with other people,” he says. “Global health is a team sport, and you need to be able to bring other disciplines in, realizing that there are other ways of doing things and we can learn from each other.” 

Dana Sand 14C is an Emory College student co-majoring in journalism and anthropology and a communications intern for the Claus M. Halle Institute for Global Learning.

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