Grant: New Investigator Award-PA:Ontario HIV Treatment Network-Biomed/Clinical Research

Despite decades of traditional prevention efforts, Canada continues to see unacceptably high rates of HIV and sexually transmitted infections (STIs) such as syphilis and herpes simplex virus type 2 (HSV-2), with a disproportionate burden among men who have sex with men (MSM). As an infectious diseases specialist physician and clinical epidemiologist, my research program focuses on clinical trials of novel strategies for the prevention, detection and management of HIV and STI co-infections. First, I lead an interdisciplinary team investigating a safe, effective new approach to HIV prevention known as pre-exposure prophylaxis (PrEP). PrEP involves daily use of anti-HIV medications by people at high, ongoing risk of HIV, but there are concerns about its acceptability, the ability of users to adhere, and other clinical issues. I am launching a pilot PrEP trial among high risk Toronto MSM that will gather preliminary data on these issues and inform the design of a future nationwide trial. My related studies in this area address other ways to optimize the clinical and public health impact of PrEP in the future. Second, given the exceedingly high burden of syphilis in HIV-infected MSM and the many negative interactions between these pathogens, I am co-leading a clinical trial of new approaches to diagnosing syphilis in HIV-infected MSM that will inform future strategies for controlling these STIs. Third, I am co-leading an international randomized controlled trial in the area of HIV and HSV-2 co-infection, studying whether the anti-herpes medication valacyclovir can slow the rate at which HIV disease progresses. Although there are several potentially harmful ways in which HIV and herpes interact with each other, valacyclovir and related anti-herpes medications are safe and inexpensive. The rationale underlying this trial and my other studies in this area is that these medications could therefore be exploited for clinical benefit by reversing these harmful effects.