Seasoned athlete. Political activist. HIV investigator. Charles van der Horst, MD, leads a multi-faceted life and passionately tackles any task.
As an athlete, he marked turning 60 by competing in 35 events that year alone, including a half Ironman triathlon. As a political activist, he was arrested on May 6, 2013, during Moral Monday protests at the North Carolina state legislature. During his subsequent trial, he became emotional on the stand explaining how the recently rejected expansion of the state’s Medicaid program would harm his patients. As a researcher at the AIDS Clinical Trials Group’s (ACTG) University of North Carolina Chapel Hill site, van der Horst continues to work on trials that are improving treatments and establishing standards of care for people living with HIV and other infections like hepatitis C.
“My favorite part of being an investigator in the ACTG is the group spirit among the investigators, site staff and the patients to push the envelope looking for better ways to treat and prevent this virus,” he says. “The good thing about medicine is that we never sit on our rear ends accepting what’s going on. We always want to find new answers, new treatments and new ways to prevent diseases of any type. The ACTG was one of the first large, government-funded groups, as opposed to beholding to the pharmaceutical industry, to really put a scientific structure on HIV research. We designed large clinical trials to find answers to diagnosing, treating and monitoring treatment of HIV.”
Watch a video of van der Horst talking about the most profound HIV research breakthrough to date and how he spends his spare time.
Van der Horst says he never chose to work in the HIV field, the virus “came to me.” As a young doctor in New York City in the early 1980s, he treated people with HIV before there was even a name for the virus or an antibody test to diagnosis it.
“I embraced the challenge of how to get answers to these nagging questions and stop the slaughter that was going on with my patients,” he says. “The time from 1981 until 1996 was a very dark period for my patients, and thus, for me. The ACTG helped keep me sane as it was a continuous race to come up with new therapies and new assays so that we could help our patients.”
Van der Horst joined the ACTG in 1986. He is most proud of the Network’s research that found treating people with HIV using three or more drugs simultaneously allowed for viral suppression, increased CD4 cell counts and immune recovery.
“This theoretically allowed people living with HIV to live a normal lifespan and the ACTG was instrumental in realizing this line of therapy,” Van Der Horst says.
His HIV research interests include investigating the treatment of opportunistic infections and AIDS-associated malignancies. Results from his ACTG study A159 found the best initial treatment for cryptococcal meningitis in people living with HIV. Cryptococcal meningitis is a serious infection of the brain and spinal column that leads to dangerous inflammation and brain swelling. The study’s results were published in the New England Journal of Medicine in 1996 and remain the standard treatment therapy today.
Cytomegalovirus (CMV) retinitis is another opportunistic infection van der Horst and the ACTG studied. This is a viral inflammation of the retina of the eye. Mark Jacobson, MD, works at the ACTG’s University of California San Francisco site. He and van der Horst worked together on the ACTG’s A151 CMV retinitis-HIV trial and other ACTG CMV studies.
“I met Charlie in 1986 soon after we had both completed our infectious diseases fellowships and were beginning careers in academic medicine,” says Jacobson. “We collaborated as junior investigators on a number of early ACTG clinical trials of treatment for CMV retinitis and cryptococcal meningitis, and subsequently, as site principal investigators and on ACTG leadership committees. Over three decades, Charlie has consistently been the most selfless and mission-driven individual in our cohort of HIV investigators. He was also the first of our group to begin advocating leadership roles for the next generation of junior investigators in the ACTG.”
In 2000, van der Horst began traveling to the ACTG’s sites in Malawi, Zambia and South Africa. He was part of the A5175 study team, which identified a safe and effective once-daily combination of antiretroviral drugs well-suited for initial treatment in diverse populations. Robert “Chip” Schooley, MD, is an investigator at the ACTG’s University of California San Diego Antiviral Research Center. He, too, worked on A5175.
“In the late 1990’s when the contemporary wisdom was that HIV therapeutics were too costly and too complex to be introduced into resource-limited settings, Dr. van der Horst was one of the few able to look forward and to eloquently articulate the medical and moral imperative of bringing contemporary therapeutics to these settings,” Schooley says. “Building on a collaboration initially formed around prevention, Dr. van der Horst led an effort to expand the infrastructure in Malawi to the point that it was one of the first places where antiretroviral therapy could be scaled up as treatment in Africa. Working with a network of collaborators throughout sub-Saharan Africa, Dr. van der Horst has been a catalyst for change that has made the world a much better place.”
When asked about the future of HIV research, it is no surprise van der Horst remains committed to his work in Africa. He also feels boosting adherence rates to treatment regimens is critical to achieving an AIDS-free generation.
“Personally, although I think aging, metabolic complications of HIV and cure are all very interesting and scientifically important for the ACTG to focus on, I am most committed to research in sub-Saharan Africa,” Van Der Horst says. “This includes cheaper and more point of care testing like diagnostic and monitoring assays; less toxic and more accessible regimens for treatment of both HIV and the associated infections and malignancies; and developing strategy studies for decreasing the drop-off of clients. We must study how to best keep people in care with no loss to follow up. Without this, there will be no concrete advances in stopping the epidemic.”