Roy “Trip” Gulick, MD, MPH, pauses every few minutes to return a colleague’s greeting as he takes a break in between sessions during the AIDS Clinical Trials Group (ACTG) Network’s leadership retreat. It comes as no surprise then that when you ask him what he likes best about being a part of the Network he replies “the people.”
“It’s such a privilege to be a part of the ACTG,” Gulick says. “Not only because I get to work with the finest people in the HIV field, but because it has been extremely rewarding. We’ve made tremendous strides and I am really proud of the real difference we have made for people living with HIV.”
The year 2014 marks Gulick’s 25th year with the ACTG.
“Trip is one of our most experienced investigators who clearly loves his work and embraces the challenges of HIV research and care with an optimistic enthusiasm,” says Joseph Eron, MD, Principal Investigator of the ACTG’s University of North Carolina Chapel Hill site. “He has led some of the most important antiretroviral trials accomplished by the ACTG. Trip is persistent in his pursuit of the best science and persuasive and unafraid to hold an opposing opinion if he believes it is right. Somehow he does all this with a smile and a sincere respect for the opinion of others.”
It was this same respect as well as a genuine concern for patients he was seeing as a young medical student in New York City in the 1980s that ultimately led Gulick to become an HIV specialist.
“I saw the first cases of what would later be called AIDS,” Gulick recalls. “These patients were widely feared. Hospital staff would leave these patients’ lunches outside their rooms and if they did have to go in, they would don protective clothing from head to toe. These patients were dying quickly and this motivated me, even as a medical student, to help.”
Gulick served as the first AIDS fellow at Beth Israel Hospital-Boston in 1989 and then completed his infectious diseases training at Massachusetts General Hospital. That is also the year he joined the ACTG. He remembers the first studies he worked on as a site investigator exploring how well and how safely people living with HIV tolerated the at-the-time investigational anti-HIV drug didanosine (or ddI) in ACTG trials 116, 117, and 118.
In 1991, he began his first faculty position at Beth Israel Hospital. He also began work on ACTG 150. The trial tested St. John’s Wort, which contained hypericin, a compound with antiviral activity in vitro, in people living with HIV with a CD4 cell count less than 300. It was a study he continued to work on after he moved from Boston back to New York City in 1993 to take a position at New York University (NYU). There, he learned two things – hypericin did not improve CD4 cell counts and he enjoyed being back in New York.
In 1998, he left NYU for a position at Cornell. Gulick has been at Cornell ever since and took the position of Chief of the Infectious Diseases Division in 2009. He is also the Principal Investigator of the ACTG’s Cornell Clinical Trials Unit.
“My life has definitely changed since becoming chief of the division,” Gulick says. “The best part of my job is that I get to do so many different things each day.”
Gulick’s daily duties run the gamut from division administrator to HIV researcher to infectious diseases clinician and teacher. He oversees Cornell’s Division of Infectious Diseases, which includes 41 full time faculty and nine fellows. For one half-day each week, he sees his own patients living with HIV – some since the mid-1990s – in the clinic. He recently was named co-chair of the National Institutes of Health (NIH) Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents, along with his mentor from Harvard, Marty Hirsch, MD. He also mentors infectious disease fellows and junior faculty, preparing them for and linking them with research and career opportunities.
“The ACTG is a great place to be a mentor because you can help provide mentees with experiences serving on study teams and scientific committees,” Gulick says. “It is especially rewarding when they then go on to chair their own research studies.”
His own research career has blossomed during his tenure with the ACTG. The first study he chaired, ACTG 359, investigated treatment options for people living with HIV who had failed to respond to the protease inhibitor class of anti-HIV drugs. Years later, he chaired A5095 which showed that a triple-nucleoside regimen of anti-HIV drugs was inferior therapy for people living with HIV who had never been on treatment. This study’s results changed treatment guidelines.
Because of all the strides Gulick and the ACTG have made with pinpointing the best treatment options for people living with HIV, he says research agendas are changing.
“I have spent a lot of my career on treatment optimization studies, trying new drugs and new strategies to help people with HIV manage the virus,” he says. “Now the challenge is beyond this field. Cure research and treatment as prevention are where we are focusing our resources.”
Gulick is currently study chair for a “treatment as prevention” trial jointly supported by the ACTG and the HIV Prevention Trials Network (HPTN). ACTG 5305/HPTN 069, the Next PrEP trial, is investigating whether anti-HIV medication combinations that include the drug maraviroc can be used as safe and effective forms of pre-exposure prophylaxis (PrEP) compared with the standard of tenofovir/emtricitabine for HIV-uninfected women and men who have sex with men.
When he is not working, Gulick enjoys running in Central Park, playing the piano and singing. He is also a big theatre fan and an avid scuba diver and was able to get a dive in after last year’s International AIDS Conference meeting in Malaysia.
“The best diving was off the island of Borneo,” he says. “The sharks and barracuda were amazing.”