The deaths were palpable.
Just six years after the start of a medical career he envisioned would be filled with helping patients heal, Richard D’Aquila, instead, found himself at the forefront of the AIDS epidemic. What he did next continues to alter the lives of those living with the disease and its precursor, the human immunodeficiency virus (HIV).
“I decided that instead of going to more funerals, I would return to the lab and pursue additional research training,” says D’Aquila, director of Northwestern’s HIV Translational Research Center and the Howard Taylor Ricketts Professor of Medicine. “I was fortunate enough to connect with virologists at Yale in 1985 with ties to scientists who had actively worked to uncover the cause of AIDS.”
That answer was revealed with the 1984 discovery of HIV.
Following a research fellowship at Yale, D’Aquila joined the faculty in New Haven, about 30 miles from where he grew up in New Britain, Connecticut. His persistent interest in developing new drugs — he nearly pursued a PhD in pharmacology before obtaining an MD at Albert Einstein College of Medicine — and his clinical background in infectious diseases, led to his recruitment by Massachusetts General Hospital and Harvard Medical School, where he was able to take leadership roles in some of the earliest clinical trials and related clinical virology research for what was still considered a largely untreatable disease.
Today, more people than ever before are finding they can manage HIV more effectively as a direct result of improved antiretroviral treatment, which is often as straightforward as taking one pill daily. In the early 1990s, D’Aquila was instrumental in moving a novel “drug cocktail” — a combination of three antiretrovirals that for the first time effectively suppressed the virus — from the laboratory into the clinic. Since then, the number of pills needed to suppress the diseases, as well as their efficacy, has steadily improved. And very recently, there is evidence that having the amount of virus in the blood consistently suppressed to “undetectable” levels can also stop transmission to others; this offers a hopeful strategy for ending the epidemic.
“The memories of what it was like in the earliest days when all that we could offer was comfort haven’t faded, but we’re living in a different world in terms of what we can now do for patients,” says D’Aquila, a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Chemistry of Life Processes Institute and director of the Third Coast Center for AIDS Research (CFAR), a National Institutes of Health-funded program operated collaboratively with the University of Chicago and various community partners. “We have medications that really work, and in turn that allows my lab, and many others, to concentrate on working toward solutions to the remaining problems faced by people living with HIV: finding a ‘cure’ and avoiding common health problems that decrease the quality of life but are not life-threatening.”
D’Aquila prefers to discuss “the sustained remission of HIV after antiretroviral medications are stopped,” rather than a cure in the traditional sense. That's because scientists are closer to slowing the virus from returning after stopping the medications than completely eliminating the virus from the body. While people living in developed nations on HIV treatment now do not suffer from the life-threatening opportunistic infections and cancers that accompanied AIDS previously, they experience more frequent and earlier disorders associated with aging. These include heart diseases and cancers that are common among those not infected with HIV. So while lifespan is beginning to approach actuarial standards, the “healthspan” is still shorter than those not infected, a challenge researchers continue to address and hope to ameliorate.
During a short elevator ride to his Feinberg School of Medicine office overlooking Michigan Avenue, the passion D’Aquila maintains for research is evident. Although he sees patients less, they still guide almost everything he does.
“We have a couple of ongoing projects in the HIV Translational Research Center where we are seeing astonishing results,” he says, noting that he couldn’t possibly shoulder the workload being carried out by medical school faculty Chisu Song and Harry Taylor, graduate students, and a postdoctoral fellow. “One of the most exciting parts in any day is learning new things from them and determining how to push different ideas forward with them.”
Research efforts focus on novel drug therapies to boost a defensive cell protein in HIV virions abbreviated as A3s and to decrease a cell's ability to replicate HIV. The goal is to achieve sustained HIV remission after antiretrovirals are stopped and decrease the persistent inflammation that can contribute to disorders associated with aging.
In another of his multiple roles, D’Aquila is director of the Clinical and Translational Sciences Institute’s (NUCATS) Center for Clinical Research, and in 2017, he was named an associate vice president of research, which positions him as a connecting point between Northwestern administration and the directors of four University Research Institutes and Centers.
In his roles with CFAR and NUCATS, D’Aquila sees himself as a catalyst for team-based approaches to clinical investigation.
“I work in a world of similar priorities for NUCATS, CFAR, and Northwestern’s Institute for Public Health and Medicine,” says D’Aquila. "Development and implementation of new interventions so they become routine medical practice and benefit society relies on community participation."
D’Aquila also is committed to helping early-career investigators establish their careers: “Making sure that young researchers own the advances in which they play
a central role is a critical step in establishing future generations of investigators who will help solve problems that today seem unsolvable.”