Improving Adherence to HIV Treatment

Jan 01, 1970

As an internal medicine intern at the University of California San Francisco in the early 1980s, Sally Hodder, MD, witnessed the AIDS epidemic early and up close. This life changing experience later inspired her to focus her career on treating and preventing HIV.

“At first we didn’t understand what people were suffering from. And when we did know what it was, we had no treatment, ” says Hodder, Principal Investigator of the AIDS Clinical Trials Group (ACTG) Network’s New Jersey Medical School (NJMS) site. “Now we have effective treatments and people are living near-normal lifespans. We have come full circle.”

Hodder is one of the many investigators responsible for transforming HIV from a death sentence to a manageable, chronic condition. After completing her training in San Francisco and at University Hospitals in Cleveland, she accepted a faculty position at Case Western Reserve University in Cleveland, Ohio. There, she focused on tuberculosis, the number one killer of people living with HIV. When her husband’s job moved them to New Jersey, Hodder took a job with pharmaceutical company Bristol Myers Squibb.

“I was part of the virology division and I worked with the ACTG,” says Hodder. “This was during the time that the anti-HIV drug atazanavir was in development. So I was able to see firsthand how a pharmaceutical company and a research network can work together to generate important data.”

Having this experience with the pharmaceutical side of research, Hodder was recruited to New Jersey Medical School (NJMS) in 2005 to build an adult HIV research program; NJMS joined the ACTG as a funded site in 2007.

“I loved pharma, but I loved the idea of building an HIV research program in Newark more,” says Hodder of her decision to leave Bristol Myers Squibb and work to successfully obtain funding to open an ACTG site at New Jersey Medical School. “This was a meaningful challenge.”

In addition to running the ACTG site at NJMS, Hodder is the Medical Director of the University Hospital Infectious Diseases Practice.

“Working with Dr. Hodder is an incredible experience,” says Christie Lyn Costanza, the New Jersey site’s Data Manager. “Her work ethic, intelligence and genuine excitement about the work we do inspire us all to be our best not only as individuals but as a team. She is always managing what seems like a million and one things but she is always present, passionate and ready to tackle the next project with a fiercely powerful approach. Following her lead, we work hard and have a lot of fun in the process.”

The site treats roughly 1,450 people living with HIV, 45 percent of patients are women, and the majority of patients are African American. The clinic population and Newark community have been enormously supportive of the HIV treatment and prevention research programs at NJMS.

“When we first became a research site, our Community Advisory Board discussed past abuses and current strategies to avoid those abuses.  We also sought the support of trusted civic and faith community leaders,” Hodder says. “We make an effort to inform the community of how their trial participation is furthering research. We hold community events where we highlight how our research is impacting Newark.”

Hodder and her team also meet the community where it is most convenient for them – in their neighborhood. When a person tests positive for HIV at a local community health center, the NJMS van may be dispatched to pick the person up and connect them with care in Newark. Despite her demanding administrative role, Hodder still sees patients two half days a week and looks forward to this time.

“Those two days are my most enjoyable days of the week,” she says.

Since women make up a significant proportion of her patients, it comes as no surprise that Hodder’s most memorable ACTG study investigated the safety of human papilloma virus (HPV) vaccine when given to HIV-infected women. “HPV is a real problem for women living with HIV,” Hodder says. “Only 10 percent of a sample of HIV-infected women in Newark had normal cervical pap smears. The ACTG study proved giving them the HPV vaccine was safe.”

Judith Feinberg, MD, is an investigator at the ACTG’s University of Cincinnati Clinical Research Site. She has worked with Hodder for many years.

“I always enjoy working with Sally on research projects,” says Feinberg. “Not only is she smart, she keeps me laughing.”

Looking toward the future of HIV research, Hodder acknowledges the importance of cure and inflammation studies. But she’s also focused on people accessing and remaining in treatment. The Centers for Disease Control and Prevention says roughly 50 percent of people living with HIV are engaged in care and only 25 percent have their viral load suppressed.

“At our site, we have used case managers, better tolerated drugs and incentives to improve adherence to treatment. The proportion of our patients having suppressed viral loads increased from 25 percent in 2005 to 75 percent in 2013,” Hodder says. “But there is still that remaining 25 percent. We need to think of innovative solutions to further improve the proportion of folks with suppressed viral loads.”