Spend 30 minutes talking with Cindy Firnhaber, MD, and one word keeps coming to mind – driven. It’s an adjective quite fitting for a woman who has moved across the world to treat women at the highest risk for developing cervical cancer.
“Women with HIV have increased rates of cervical dysplasia due to HPV and tend to show signs of these lesions 10 to 15 years earlier than women who do not have HIV,” Firnhaber says. “So we are seeing young patients in their mid-20s. It’s an incredible injustice and not how we were intended to live.”
Firnhaber is the Technical Director of the ACTG’s Clinical HIV Research Unit (CHRU) in Johannesburg, South Africa. The CHRU is a non-profit research unit, providing treatment and prevention services for patients with HIV and associated conditions and is affiliated with the University of Witwatersrand Department of Medicine. Firnhaber has been involved since the CHRU’s inception in 1997. And she has also been the Manager of Right to Care’s Cervical Cancer program since 2008. Right to Care is a South African non-profit involved in the implementation and strengthening of care for HIV infected people.
In the United States, young men and women are encouraged to take Gardasil, a three-dose injection proven to guard against the four strains of the human papillomavirus that lead to 80 percent of cervical cancer and genital warts cases. But this method of prevention is not available to the public sector yet in South Africa. Firnhaber relies on regular screenings to catch cases of HPV among her female patients in South Africa.
“They haven’t had good access to screenings in the past, so we are changing that,” she says. “Often, where they were going to get their HIV care was not equipped to perform pap smears. So they would have to travel to another location for that test and they wouldn’t always go. We started providing paps in HIV clinics and now there are 25 other clinics in South Africa providing these dual services that we began at Right to Care.”
In addition to the goal of increasing the number of women screened for HPV, Firnhaber says the question she is hoping to answer with her research concerns treatment of women with HIV and HPV.
“Cervical dysplasia is a pre-cancerous lesion and the treatment of these is not as effective in women with HIV because the disease burden is higher and the lesions are in more areas of the cervix,” Firnhaber says. “I am looking for more effective ways of treatment.”
Firnhaber earned her medical degree from the University of Colorado and then spent six months volunteering at Musami Mission in Zimbabwe as a medical officer. Her time in Zimbabwe inspired an interest in treating patients with infectious diseases and instilled a love of the continent in her. In 1996, she began treating patients with HIV in South Africa and met Ian Sanne, MBBCH, FCP, the Founder and Managing Director of the CHRU and Right to Care.
In 2000, she returned to Colorado for four years, but continued treating patients with HIV. By 2004, she headed back to Johannesburg excited for the President’s Emergency Plan for AIDS Relief or PEPFAR, a funding source available to organizations like Right to Care.
“I knew anti-retroviral therapy was allowing women with HIV to live longer and that was why getting a regular pap was going to be so important for early detection and prevention of HPV,” she says. “Both of these diseases are preventable and my driving force is keeping these women alive for their children.”
At the 2012 ACTG Network Meeting, Firnhaber received the Constance B. Wofsy Women’s Health Investigator Award. The award recognizes investigators who have made significant contributions to research in HIV-infected women and who embody qualities exemplified by Dr. Wofsy, the late Co-Director of the AIDS Program and Associate Chief of Infectious Diseases at San Francisco General Hospital. Awardees mentor junior investigators, provide on-going clinical care for HIV-positive women and conduct research.