This month the ACTG Network experienced unprecedented losses of cherished members of our community. In honor of our colleagues, we have asked the people who knew them best to share their thoughts. We send our condolences to the families, friends, and colleagues of those who have passed away this month and over the last year.
John G. Bartlett, MD
-Richard E. Chaisson, MD

Dr. John Bartlett, an iconic and visionary leader in infectious diseases and HIV/AIDS died on January 19, 2021, at the age of 83. Dr. Bartlett was an original principal investigator in what became the ACTG and a legendary scientist, clinician, teacher, and writer who made major contributions to an astonishingly wide range of infectious disease threats. In addition to his leadership within the ACTG, Dr. Bartlett played a pivotal role in leading numerous other professional and public health entities, including co-chairing the Department of Health and Human Services HIV Guidelines Panel, serving as president of the Infectious Diseases Society of America, and chairing the board of directors of Baltimore’s Health Education Resources Organization (HERO), one of the earliest AIDS advocacy groups in the country.
Born in upstate New York, John studied medicine at SUNY Syracuse, was an intern at the Peter Bent Brigham Hospital in Boston, and a resident at the University of Alabama, Birmingham, where he planned to become a cardiologist. He was drafted into the U.S. Army in 1965 and sent to Vietnam where he helped run a hospital that cared for soldiers with a variety of infections.  Returning to the U.S., he decided to study infectious diseases because “you can look in the microscope and see the enemy.” He began studying anaerobic infections and helped elucidate the causes of both pulmonary and abdominal infections caused by anaerobes, publishing a number of seminal papers on the subject. He then focused his attention on antibiotic-associated colitis, and discovered the toxin produced by Clostridium difficile (C. diff) that caused the disease. His landmark study of C. diff colitis, published in the New England Journal of Medicine, led to the development of diagnostic tests and treatments for this extremely common and debilitating disease.
John was recruited to Johns Hopkins School of Medicine in 1980 to lead the Infectious Disease division and over the next 26 years built it into a global leader across the entire spectrum of infectious diseases. In 1982, his interests shifted to the AIDS epidemic and he and his colleague Frank Polk mobilized resources within the institution to both care for patients and better understand the disease. He created the second dedicated inpatient AIDS ward in the world, after San Francisco General Hospital, and recruited a multidisciplinary team of clinicians to provide care and develop treatments.
Over the next 30+ years he became an internationally renowned expert in HIV therapeutics, always driven by his own direct involvement in caring for patients. John maintained a busy clinic caring for people living with HIV and other infections, taught on the inpatient wards, and always attended on the AIDS Ward on Christmas, giving gifts to every patient while wearing a Santa hat. He befriended Garey Lambert, a prominent local AIDS activist who had written highly critical articles about the medical community’s response to the epidemic. John and Garey became close friends; Garey relied on John’s insights into HIV research, and John brought Garey to scientific meetings, including ACTG meetings, to both learn and provide community perspective to researchers and clinicians. Following Garey’s death, the Hopkins HIV Research Clinic was named in his honor, and a large portrait of Garey hung over John’s desk for the remainder of his career.
John was one of the most sought-after speakers on HIV and infectious diseases. He lectured around the world with an absolutely brilliant ability to synthesize data, explain it to scientists, clinicians, and laypeople, and look into the future to predict what would come next. John’s “Top 10” lists of advances in HIV and infectious diseases were extremely popular talks at conferences and have been emulated by many. He was an early adopter of internet tools, establishing an HIV website, conducting online clinical conferences for clinicians in Ethiopia, Uganda, and India, and pioneering telemedicine for inmates in the Maryland state prison system. His teaching in the classroom and at the bedside was equally awe-inspiring, with his encyclopedic knowledge and insightful interpretation. He wrote prodigiously, producing dozens of books, including his “Pocket Guide to HIV Infection” and “The Medical Management of HIV Infection,” now in their 19th and 17th editions, respectively. In addition to HIV, he was a leader in areas as diverse as bioterrorism, emerging infections, community-acquired pneumonia, and antimicrobial resistance.
John was famed for his extraordinary work ethic, maintaining a schedule that made most people weary just to think about. He arrived at his office in the wee hours of the morning and worked for 15 hours, but still managed to be home for dinner and spend the evening with his wife Jean and their three children, Valerie, Josh, and Scott. He explained his secret to me once when he returned from a two-week vacation with Jean in Australia and showed me the hand-written manuscript he had produced while they were there, the first edition of his “Pocket Guide to HIV/AIDS.” I scolded him and told him he was supposed to have been on vacation, and he responded, “Yes, but you have to understand that Jean sleeps at night.” In addition to time spent with his family, John was a talented artist, and he once took a sabbatical to Paris to paint.
Following his retirement in 2014, John and Jean moved to Tupelo, Mississippi, where he continued to write, read, lecture, and serve on committees, but he was able to spend even more time with friends and family. Sadly, Jean Bartlett died in October 2020.
In 2016 the Johns Hopkins HIV and viral hepatitis clinics were merged into a magnificent new facility named The John G. Bartlett Specialty Practice. The clinic continues the work that John began 36 years ago, caring for people from all walks of life with HIV infection. 
John’s death is a huge loss to the HIV and medical communities. He commented at his retirement, “It would be difficult to find another discipline in medicine that has such extraordinary diversity, surprises, value in patient care, and clinical relevance for both domestic and international applications.”[1] Similarly, it would be difficult to name another individual who contributed more to our understanding of, provided better care for, or helped educate more practitioners to combat the diverse spectrum of microbes that threaten human health and happiness than John Bartlett.

[1] Bartlett JG. Why infectious diseases. Clin Infect Dis. 2014, 59(suppl 2):S85–S92,
David Katzenstein, MD
-Seble Kassaye, Michele Barry, Eran Bendavid, Mark Holodniy Dennis Israelski, Rami Kantor, Bonnie Maldonado, Thomas Merigan, Julie Parsonnet, Jonathan Schapiro, Robert Shafer, Upi Singh and Dean Winslow

Last week, the world lost a special person, David Katzenstein, MD. David was a good friend, brilliant scientist and researcher, and phenomenal mentor. His enthusiasm and passion for his work and life was infectious. Born in Hartford, CT, David received his BA and MD from the University of California, San Diego. He began his career in the early 1980s working with underserved populations at a Native Tribal clinic in New Mexico and with people living with AIDS at the Haight Ashbury Clinic in San Francisco. As a junior faculty member, he conducted CMV research at the University of Minnesota and then took a position working as a microbiologist at the University of Zimbabwe in Harare between 1985 and 1987. When the devastating effects of the HIV pandemic became apparent, David pivoted to join the early pioneers conducting HIV research. Between 1987 and 1989, he was a Senior Research Fellow at the Center for Biologics, Evaluation, and Research at the Food and Drug Administration. In 1989, David joined the faculty at Stanford University where he remained until his retirement to emeritus status in 2017.
David’s involvement with the ACTG dates back to his earliest days at Stanford, where he served as Associate Medical Director of the Stanford AIDS Clinical Trials Unit, a position he held for 25 years. As a beginning clinical investigator, David became co-chair with Scott Hammer (then another early-stage investigator) of ACTG 175, a phase 3 trial comparing ZDV monotherapy to ddI monotherapy or combination therapy of ZDV+ddI or ZDV+ddC. This early pivotal trial of nearly 2500 participants demonstrated the superiority of ddI and of ZDV+ddI over ZDV alone.  Virologic analyses from the study helped lay the foundation for the use of virus load monitoring as a surrogate marker for ARV efficacy. 
In the decades to follow, David contributed to dozens of ACTG trials, New Works Concept Sheets, and Data Analysis Concept Sheets as chair, co-investigator, team member, and virologist. Of the nearly 300 publications listed on his CV, nearly one-third were related to his work with the ACTG. As a virologist, David became a leader in the field of HIV drug resistance, supported by numerous NIH grants. For many years he directed the ACTG Virology Advanced Technology Laboratory, as the Virology Specialty Laboratories were then known.
Early on, David recognized the disparate impact of HIV in low-resource settings, and was a pioneer in perinatal HIV transmission prevention and adapting technologies to different settings.
His time in Zimbabwe in the late 1980s had a lasting impact on him, and he returned frequently to build collaborations and help mentor emerging investigators. Notably, in 2000 David received a Distinguished Clinical Scientist Award from the Doris Duke Charitable Trust to explore affordable, feasible treatment for women living with HIV in Southern Africa. He emphasized the importance of studying drug resistance in Africa and published some of the first studies of HIV drug resistance in non-subtype B viruses. Following his retirement from Stanford University in 2017, David became the director of the Biomedical Research Training Institute in Zimbabwe, where he led the molecular diagnostics laboratory to support laboratory monitoring of community-based treatment programs in Zimbabwe.  
In all his work, David engaged researchers and trainees from different parts of the world. Sitting in a world-class laboratory, he helped to train and mentor many rising scientists and physicians. His collaborations spanned from industry to community, bringing forth novel approaches. David’s major strength was his scientific imagination and how he shared this with his friends and colleagues. He had a wonderful, warm manner, which made him a great mentor, friend, and leader. Generous with his time, effort and ideas, David was a cherished teacher for many young and mid-career physicians and scientists, now scattered throughout different academic institutions and agencies in the U.S. and around the world. With his encyclopedic knowledge, deep intellect, and strong belief in social justice, David helped level the playing field for those from diverse backgrounds. He exemplified academic excellence and he inspired those around him to aspire to high achievement, all with the goal of contributing to the common good. He nurtured the careers of clinicians, basic and social scientists, while encouraging multidisciplinary efforts to tackle the global HIV pandemic.
David lived every day to the fullest, accomplishing more each day than many would in the course of a week or a month. He worked tirelessly and with great joy, giving of himself without reserve. As the true free spirit that he was, David intermingled his academic pursuits while basking in the wonders of this world, always seeking adventure and new experiences. His work led to his many travels around the world, and indeed, his experiences were woven intricately into his work life and would easily read as a bucket list for a true adventurer.
David lost his life to COVID-19 on January 25, 2021 in Harare, Zimbabwe. He died in the place that he loved, cared for in the hospital by those that he mentored along the way. The outpouring of grief at his loss is a testament to David, who helped so many, touched so many lives, improved the livelihoods of innumerable men and women, inspired, and motivated. Friend, family, colleague, mentor – truly a one of a kind. His death leaves us all poorer, but his life serves as an example to us all. Rest in peace, David – we will continue to draw on the foundation with which you left us. Fearless, eager, and joyful.
Professor James G. Hakim
-Nagalingeswaran Kumarasamy, MD

The world lost an African medical legend when Dr. James Hakim passed away in Harare, Zimbabwe on January 26, 2021 after battling COVID-19. His death marks an enormous loss to Africa and low- and middle-income countries around the world. His contributions to science and medicine were invaluable. He was an exceptional physician, a brilliant researcher, and a committed teacher. He was a humble and respected person, both in the medical and patient communities.
Dr. Hakim studied medicine at the University of Makerere in Uganda (MBChB) and specialized in internal medicine in Kenya (MMed-internal medicine), at Royal Colleges of Physicians UK (MRCP-UK); University of Newcastle, Australia (MMedSci-Clinical Epidemiology); and at University of Cape Town (Health Professions Education). He did a post-doctorate in Cardiology at Aachen, Germany and was a fellow of the Royal Colleges of Physicians of London and Edinburgh.
Dr. Hakim was the Professor of Medicine, formerly Chair of Medicine, at the University of Zimbabwe College of Health Sciences. In addition, he was the Director of the UZ Clinical Research Centre and a co-PI in the UZ-UCSF Collaborative Research Program. He was engaged in a broad range of HIV/AIDS research, including ARV therapy, prevention, opportunistic infections, and perinatal HIV.

Dr. Hakim was the CRS leader of one of the initial ACTG International sites established in the early 2000s, now known as the Milton Park Clinical Research Site in Harare. He played a key role in advancing the ACTG’s original international science agenda and was one of the co-chairs for the ACTG’s flagship international study, A5175 (Once-Daily PI + Non-NRTI Regimens for Initial Tx in Resource-Limited Settings).
Dr. Hakim was a member of the ACTG Executive Committee at the time of his passing. Previously, he was a member of the Scientific Agenda Steering Committee and Antiretroviral Therapy Strategies Transformation Science Group. He authored numerous ACTG Publications. He authored and co-authored more than 200 manuscripts and book chapters and was most loved for his passion for mentorship and for promoting younger investigators.
He was involved in seminal HIV research in collaboration with MRC-CTU (UK), NIH (USA), EDCTP (Europe), Rockefeller Foundation, DIFD, and Wellcome Trust. He was the PI of the UZ Medical Education Partnership Initiative- NECTAR, a PEPFAR and NIH-funded program (2010-2016), which aimed to improve medical education capacity and research capacity strengthening to cope with the heavy burden of all diseases, especially HIV/AIDS in Africa. In 2019, he received the Ward Cates Spirit Award for his outstanding commitment and leadership to health, scientific excellence, and generosity in mentorship and support.
Dr. Hakim was a dear friend and a respected collaborator. Dear James, we cannot get our minds around losing you. Rest in peace.
Frances Canchola, RN
-Michael Dube, MD and members of the USC CRS

With great sadness, the USC CRS and ACTG Network mourn the loss of Frances Canchola, RN. Frances had been a research nurse in the unit since January 1994. She joined us in the pre-HAART era and was a tremendous contributor to trials of disseminated MAC treatment. Frances was there with us and her patients as we transitioned into a period where HIV was no longer a progressive, fatal disease. Over the years she contributed to countless clinical trials in the ACTG. Frances was active in her role right up to the point when she was diagnosed with COVID-19 in November 2020 and ultimately succumbed to its complications in January 2021 after a prolonged hospitalization.
Frances was a bright light in the lives of her patients and co-workers and always willing to learn new tasks. Her sense of humor was remarkable and uplifting to those around her. Frances was able to support many patients and co-workers with her bright personality. When out for dinner, we could always count on Frances to be the instigator for a round of hilarity. We, and her patients, will miss her tremendously but feel so grateful for having known her.

In January, the ACTG launched version 2 of the ACTIV-2/A5401 protocol introducing a new investigational agent from Brii Biosciences. The agent is a combination of two monoclonal antibodies, BRII-196 and BRII-198, to treat early COVID-19. To read more, see the press release from January 5th HERE.
Investigating Weight Gain Associated with ARV Switch to INSTIs – DACS 348/1

Research suggests that integrase strand transfer inhibitors (INSTIs) are associated with greater weight gain compared to other HIV medications. In order to gain further insights into this issue, Lake and colleagues looked at data from participants enrolled in A5001 and A5322 (studies providing long-term follow-up of people previously enrolled in ACTG randomized clinical trials) from 1997-2017 who switched to an INSTI. They assessed weight gain per year, before and after the switch, taking into account other important variables including age, sex, race/ethnicity, baseline body mass index (BMI), lowest CD4+ T cell count, smoking, diabetes and follow-up time with suppressed (<200 copies/mL) HIV-1 viral load. The study population included 972 adults who switched to INSTI, 81% male and 50% non-white. Median age at switch was 50 years, CD4+ T cell count 511 cells/uL and BMI 26.4 kg/m2.
DACS 348/1 found that among virally suppressed participants, those who were women, Black or 60 years or older, gained more weight in the two years after they switched to INSTI compared to the two years prior. After adjusting for the variables described above, being white or Black, 60 years or older and obese (BMI >30 kg/m2) were associated with greater weight gain following the switch to INSTI among women. Being 60 years or older was the greatest risk factor for men.

Editor’s Clinical Impact Statement: This information adds to the growing body of evidence that INSTIs are associated with weight gain. The amount of weight in each person varies and there are many benefits to using this class of anti-HIV medicine. We still need to learn more about this issue.

Lake, J. E., Wu, K., Bares, S. H., Debroy, P., Godfrey, C., Koethe, J. R., McComsey, G. A., Palella, F. J., Tassiopoulos, K., & Erlandson, K. M. (2020). Risk Factors for Weight Gain Following Switch to Integrase Inhibitor-Based Antiretroviral Therapy. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America71(9), e471–e477.
Diving Deeper into Low Resistance Profile of Dolutegravir+3TC – A5353/7

The last few years have witnessed increased interest in treating HIV with two instead of three active drugs. In particular, the two-drug combination of dolutegravir plus lamivudine (3TC) garnered a lot of interest after two large clinical trials (GEMINI 1 and 2) showed it was effective among people who were new to treatment through 96 weeks. It was against this backdrop that a review article in the journal AIDS and Human Retroviruses commented on the strengths of dolutegravir plus 3TC and highlighted the regimen’s high barrier against resistance. Specifically, they noted the lack of resistance to either dolutegravir or 3TC in the large clinical trials through 96 weeks and in other studies.   
In order to provide additional information on how well the combination of dolutegravir plus 3TC can be expected to fend off resistance during treatment, we shared our experience from A5303 in a Letter to the Editor of AIDS and Human Retroviruses. In the letter, we described the three (out of 120) participants who experienced virologic failure in A5303 and the additional probes we undertook (deep sequencing and phenotyping) to better understand our observations in the study. We reminded readers of our earlier report that one of the three participants with virologic failure in A5303 developed resistance mutations to both 3TC (M184V) and dolutegravir (R263R/K). We noted that deeper probes did not reveal evidence that the resistance mutations were present before taking the drugs (concluding that resistance developed in relation to treatment). Resistance to 3TC is well known to make the drug inactive, whereas the resistance mutation to dolutegravir did not seem to affect the activity of the drug or others in the integrase inhibitor class in a clinically meaningful manner. The patient who developed resistance was not consistently adherent, which we speculated led to the resistance.
Editor's Clinical Impact Statement: From this study, resistance to 3TC and dolutegravir is rare but can occur.

Taiwo, B. O., Quiñones-Mateu, M. E., Smith, K., Zheng, L., Gulick, R., Nyaku, A. N., Sax, P. E., Ha, B., Kumwenda, J., Olefsky, M., Godfrey, C., & Wallis, C. (2020). Prior Case of Resistance on Dolutegravir Plus Lamivudine Dual TherapyAIDS Research and Human Retroviruses36(4), 254–255.
Impact of DAA on Immune Activation among People Living with HIV-HCV Coinfection– A5329/1
Coinfection with hepatitis C virus (HCV) is common among people living with HIV. Prior to the advent of HCV direct acting antivirals (DAAs), coinfection was a major cause of liver-related morbidity and mortality, including cirrhosis, liver failure and hepatocellular carcinoma. Fortunately, DAAs lead to sustained virologic response (SVR), or cure, in most patients and has been linked to decreased mortality and cancer. HCV infection is also associated with other non-hepatic conditions including cardiovascular disease, Parkinson’s disease, and type 2 diabetes mellitus. While the causal relationship between HCV infection and these conditions is not fully established, it may be partly explained by HCV-induced systemic inflammation, which has been associated with immune dysfunction, morbidity, and mortality. 
In order to better understand the role of inflammation, study A5329 evaluated the safety, tolerability, and efficacy of HCV treatment with paritaprevir/ritonavir/ombitasvir plus dasabuvir (PrOD) with or without ribavirin (RBV) in virally suppressed people living with HIV HCV genotype-1 coinfection. Researchers examined changes in plasma inflammatory markers, including soluble CD14 (sCD14), Interferon Induced Protein 10 (IP10), soluble CD163 (sCD163), Interleukin-6 (IL-6), Interleukin 18 (IL-18), Monocyte Chemoattractant Protein 1 (MCP1), Autotaxin (ATX), and Macrophage-2-Binding-Protein (Mac2BP), over the course of treatment. 
SVR rate was 93%. At baseline, cirrhosis was associated with higher ATX and MCP1, women had higher ATX and IL-6, older age was associated with higher Mac2BP, higher BMI was associated with higher ATX, and HIV-1 protease inhibitor use was associated with higher sCD14. Among those who experienced SVR, IP-10, ATX, and Mac2BP declined by week two, IL-18 declined by the end of treatment, sCD14 did not change, and sCD163, MCP1, and IL-6 levels only changed at a single time point. 
These findings indicate that markers of immune activation in HIV hepatitis C coinfection are likely partly attributable to age, sex, cirrhosis, BMI, and/or kind of antiretroviral therapy. Paritaprevir/ritonavir-ombitasvir-dasabuvir is a highly effective regimen that is associated with variable declines in immune activation markers.
Editor’s Clinical Impact Statement: This study confirms the importance of treating hepatitis C to lower inflammation in the body.

Anthony, D. D., Sulkowski, M. S., Smeaton, L. M., Damjanovska, S., Shive, C. L., Kowal, C. M., Cohen, D. E., Bhattacharya, D., Alston-Smith, B. L., Balagopal, A., & Wyles, D. L. (2020). Hepatitis C Virus (HCV) Direct-Acting Antiviral Therapy in Persons With Human Immunodeficiency Virus-HCV Genotype 1 Coinfection Resulting in High Rate of Sustained Virologic Response and Variable in Normalization of Soluble Markers of Immune Activation. The Journal of Infectious Diseases222(8), 1334–1344.
Why Are Some People Living with HIV Unable to Eliminate Residual Viremia? -- A5321/25
Persistence of detectable HIV despite perfect ART adherence can be worrisome, because reaching undetectable is a huge goal for many people living with HIV. Why then do some people become undetectable and others do not? We tried to answer this question using information gained from more than 300 participants of A5321. When participants entered A5321, many measurements and samples were taken. We looked at everything that has been done with these measurements and found that males (assigned at birth) and people who were more obese tended to not reach undetectable levels of HIV. Sex-based differences in viral loads have been seen for many years and more studies are ongoing to find out why obesity is important. Some researchers think HIV may hide in body tissues with lots of fat but we did not obtain fat biopsies in A5321 to look at this directly. It’s always beneficial to exercise, but now we see hints that people with lower body mass indexes were more likely to be undetectable. While this will not be true for everyone, it is one of the first insights into why certain people may not reach undetectable levels of HIV.
Editor’s Clinical Impact Statement: This study tells us ideas to look further into why people have low levels of virus detected despite being on HIV medicines. We still need to understand if these low levels of virus have an adverse impact on people.

Cyktor, J. C., Bosch, R. J., Mar, H., Macatangay, B. J., Collier, A. C., Hogg, E., Godfrey, C., Eron, J. J., McMahon, D. K., Mellors, J. W., Gandhi, R. T., & ACTG A5321 Team (2020). Male sex and obesity are associated with residual plasma HIV-1 viremia in persons on long-term antiretroviral therapyThe Journal of Infectious Diseases, jiaa373. Advance online publication.
On and around February 7thwe will be sharing photos and quotes from Black members of our network about the importance of National Black HIV/AIDS Awareness Day. To lead us into February, Black History Month, CAB member Morénike Giwa Onaiwu writes about this year’s theme “We’re in this Together.”

-Morénike Giwa Onaiwu
For over two decades, National Black HIV/AIDS Awareness Day (NBHAAD) has been commemorated annually on the 7th of February. This also happens to be the day that I was born, so as a Black mother in a serodifferent family, typically the day has been dually meaningful for me and my family. However, given the tumultuous events of the past year, in 2021 I think the significance of this particular NBHAAD to the collective community is particularly evident.
This year’s theme for NBHAAD was initially selected to encourage community-wide recognition of the importance of increasing access to HIV prevention, testing, and treatment services through promoting greater support and awareness within the Black community. The theme, “We’re in This Together,” is especially poignant in this very moment when many of us are mired in the midst of a triple pandemic: COVID-19, HIV, and various forms of longtime systemic racial injustice. The critical need for conversation, cooperation, and collaboration cannot be emphasized enough.
I am the daughter of West African immigrants, primarily raised in the United States. I have been an ACTG CAB member for over a decade, and as someone who is proud of all aspects of my heritage, I am grateful for the measurable impact of our network’s accomplishments on the global HIV community. I acknowledge the tireless efforts of our community advocates, researchers, study participants, staff, and allies, and I applaud them. But you and I both know that it’s not enough; not nearly enough.
We know that in numerous parts of the world the factors that are associated with having and/or acquiring HIV are disproportionately present within the Black community...youth as well as adults. We know that the lives of Black people are often laden with tremendous obstacles even in “Global North” countries with greater resources, such as the United States. We know that in the Black community astonishing disparities persist; that countless lives are still being lost; that unmet needs abound. That stigma, subjugation, and dehumanization - because of HIV, race, gender, sexuality, socioeconomic status, age, and other factors - are often not the exception, but the rule.
If “Black Lives Matter” the way we say they do, now is the time for renewed concern and action, and it is going to require a genuine, sustained commitment from us all, no matter your background, no matter your role. The Black community is resilient and resourceful, but we did not create racism and we should not have to solve it alone. It is all of our responsibility to use our knowledge, our privilege, our influence, and our connections to usher in concrete, scalable mechanisms to achieve health equity and inclusion for all, not only for some. This can only be possible if we are willing to listen and learn; if we permit ourselves to be uncomfortable; if we pool our resources; if we are open to change. If we truly want a better future for us all, then we need to let go of our fears and demonstrate through our words, our coin, and our action that moving forward, we’re in this together.
Nwora Lance Okeke, MD, MPH
Nwora Lance Okeke, MD, MPH is an Assistant Professor of Medicine in the Division of Infectious Diseases at Duke University. He is currently the site investigator for ACTG clinical trials at Duke including A5332 (REPRIEVE) and A5401 (ACTIV-2). Dr. Okeke has been a member of the Comorbidities Transformative Science Group (CTSG) since December 2019. As a committee member and junior investigator from a non-ACTG site, Dr. Okeke spends his time on the CTSG informing other early-stage investigators at sites without ACTG affiliation on the vast scientific resources available through the ACTG. These resources include access to biospecimens, data repositories, and strategic networking with leaders in HIV research.
Dr. Okeke received his undergraduate degree from Xavier University of Louisiana in 2002 and his medical degree at Stanford University School of Medicine. He completed his Internal Medicine and Infectious Disease training at Duke University. He also holds a Master’s Degree in Public Health in Epidemiology from the Gillings School of Public Health at the University of North Carolina-Chapel Hill.
Dr. Okeke’s research focuses primarily on the intersection between cardiovascular disease and chronic HIV infection. His early work focused on the use of metabolomic profiling to define phenotypes of cardiovascular disease risk among people living with HIV. More recently, he has primarily focused on his work as a health services researcher developing innovative interventions to optimize cardiovascular disease risk management among people living with HIV. He is currently the principal investigator for a National Heart, Lung and Blood Institute (NHLBI) K23-supported pilot implementation trial assessing a telehealth social work-based intervention for the reduction of cardiovascular disease risk among people living with HIV (SWOBI-CVD). He is also a co-investigator on a NHLBI U01-funded project assessing a nurse-based intervention to extend the HIV treatment cascade to CVD risk management (EXTRA-CVD). Dr. Okeke has extended his health services research expertise to the realms of PrEP implementation at urgent care centers in the South and at historically Black colleges and universities (HBCUs) in North and South Carolina, currently leading implementation projects in both settings. He also maintains a translational research portfolio continuing with a most recent interest the dual effects of tobacco use and HIV on vascular inflammation.
Dr. Okeke currently serves as the Associate Director of the Developmental Core at the Duke Center for AIDS Research (CFAR). He is also the Associate Program Director of Duke’s Infectious Disease Fellowship Program. In both roles, Dr. Okeke has committed to uplifting the next generation of HIV researchers and clinicians. He is most proud of the diverse group of 10 undergraduates, medical students, and infectious diseases fellows that he personally mentors hopefully towards careers in HIV research.
This year the ACTG Network added five new core ACTG Clinical research sites. Over the next few months, we will spotlight each one so the network can get to know more about them.
De La Salle Medical and Health Sciences Institute, Dasmariñas City, Philippines

Founded in 1979, the De La Salle Medical and Health Sciences Institute (DLSMHSI) is one of the leading private higher education institutions in the Philippines. It is a full-complement medical and health allied institution that provides holistic, premium medicine, healthcare, research services, and health professions education in a loving environment as it pursues its commitment of nurturing life. DLSMHSI is located in the heart of Dasmariñas City, Cavite, which is a province south of Metro Manila, the capital of the Philippines. Dasmariñas City has a population of 3.5 million people and De La Salle is the primary tertiary healthcare facility in the city.
De La Salle has a Level 3 Philippine Health Research Ethics Board (PHREB) accredited research center, the De La Salle Angelo King Medical Research Center (DLS-AKMRC). It is an established site for international clinical trials due to its capability to conduct Phase 1-4 clinical trials. DLS-AKMRC has extensive experience in TB research, including adult and pediatric therapeutic strategies, prevention strategies, and management of associated infections (such as HIV, viral hepatitis, and extra pulmonary TB).
In November 2016, it became a protocol-specific trial site for “Protecting Households on Exposure to Newly Diagnosed Index Multidrug-resistant Tuberculosis Patients (PHOENIX)” under the Emory/CDC CTU. PHOENIX was a landmark trial which paved the way for the site to become a Clinical Research Site (CRS). The site is led by Melchor Victor Frias, MD (CRS Leader) and Maria Tarcela Gler, MD (CRS Coordinator). DLSMHSI CRS prides itself on having a full complement of young and passionate investigators, nurses, coordinators, regulatory and finance staff, data managers and encoders, laboratory staff, social workers, and drivers. It has also established a community advisory board (CAB) to broaden the collaboration between the CRS and volunteers in the community.
As a new core site in the ACTG network, the site will operate efficiently and looks forward to contributing consistently to the evolving research priorities of the network through active involvement in protocol development and implementation, as well as community engagement.
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