Care for an Overlooked Pandemic

By Roger AndersonFebruary 13, 2017

When Claudia Hawkins, medicine: infectious diseases, arrived in Zimbabwe for the first time, the reality of Africa’s AIDS epidemic was stark. The horror was quantifiable.

“So many in-patient admissions were AIDS related — up to 90 percent — that physicians didn’t even bother testing for the disease,” says Hawkins, of her mid-’90s medical student visit. “Even if a diagnosis could be confirmed, there were no real treatment options at that time. Some days, 60 patients would arrive, and by morning, half of them were dead.”

In the weeks that Hawkins spent in the middle of a global health crisis, the disease hit home. Her sister and brother-in-law, living in Zimbabwe at the time, lost two relatives to AIDS.

“You couldn’t help but be affected by that,” Hawkins recalls.

After finishing her medical residency in 2002, Hawkins sought a return to Africa. A fellowship with Northwestern renowned global health expert Rob Murphy, the John Philip Phair Professor of Infectious Diseases, was the opportunity she was looking for.

After working with Murphy in Nigeria at the start of the President's Emergency Plan for AIDS Relief (PEPFAR) — a multibillion-dollar, US-led initiative to address the global HIV/AIDS epidemic — Hawkins accepted a position as clinical director of the PEPFAR funded Management and Development for Health (MDH) HIV Care and Treatment Program in Dar es Salaam, Tanzania.

“That is when I became interested in viral hepatitis-HIV co-infection research,” says Hawkins. “We were seeing HIV patients with obvious signs of liver disease related to the hepatitis B virus (HBV), but no one had any idea what the prevalence of HBV co-infection in HIV patients was at that time.”

Hawkins and her colleagues conducted one of the first studies of HIV/HBV co-infection in Tanzania in patients enrolled at MDH HIV clinics, revealing a prevalence of co-infection of approximately 7 percent. Significantly higher rates of mortality were also observed in these patients compared to those who had HIV without HBV infection.

The work produced data necessary for Hawkins’s National Institutes of Health K23 award. The ongoing, five-year project exploring co-infection in greater detail brings Hawkins to Tanzania two or three times each year to oversee the research.

“The dedication of the team on the ground in Tanzania is remarkable. They are doing a tremendous job helping to conduct a study with few resources and a very limited budget,” Hawkins said after one recent trip. “This is a very mobile patient population so one of the challenges has been getting research participants to come back for their annual study visit. The nurses and tracking team are vital to this process.”

Preliminary results confirm that co-infected individuals have more aggressive hepatitis B and higher rates of advanced liver disease and liver–related mortality. A parallel project by Hawkins in Nigeria is helping prove the value of antiviral therapies, particularly in co-infected individuals

“Since the start of the AIDS epidemic, the focus has been so much on HIV that viral hepatitis has become a neglected problem, especially in Africa,” says Hawkins. “Hepatitis B maintains a place somewhere in the global health background despite the fact that an estimated 240 million people are living with the infection and liver disease related to chronic viral hepatitis continues to be a leading cause of mortality worldwide. Only in the past few years have international health authorities begun to recognize the scale of this silent killer.”

Hawkins’ efforts helping to characterize HBV disease have also informed the development of care guidelines in Tanzania. Hawkins, who is collaborating with Murphy and Richard Green, medicine: gastroenterology and hepatology, on the project, credits the infrastructure established in Sub-Saharan Africa to combat HIV/AIDS with helping study other diseases, like hepatitis B.

“It’s amazing to see the changes at the clinic level in a place like Dar es Salaam. When I first arrived in Tanzania there were four HIV Care and Treatment sites and now there are well over 100,” says Hawkins. “The AIDS problem is by no means solved, but at least people in most urban areas of Tanzania can walk into a clinic, get treatment, and return home to live their life.”

A scientist, educator, and clinician, Hawkins sees patients about once a week as director of the viral hepatitis-HIV co-infection clinic at Northwestern Memorial Hospital. With new direct-acting antivirals, the clinic has treated and cured in the past year more than 80 patients infected with hepatitis C virus. She is also embarking on studies investigating potentially curative therapies for hepatitis B.

“It’s an exciting next phase, but developing a cure for HBV is just the first step. Making these drug accessible and affordable to places with the biggest need is an equally important and difficult task,” says Hawkins. “Twenty years ago, no one thought you could get HIV treatment to remote parts of Africa. If we use the PEPFAR efforts as a model, new treatments or a potential cure for hepatitis B could be accessible all over the world.”

Claudia Hawkins