Rebecca Hoh never envisioned herself working in HIV research — let alone in science. In fact, she was an undeclared major until theRebecca Hohdeath of her father steered her to dietetics.
But a serendipitous request from a professor to do nutritional counseling with HIV-positive patients led to a more than 20-year career at the University of California, San Francisco (UCSF), where the amfAR Institute for HIV Cure Research is based. She works closely with Institute researcher Dr. Steven Deeks on SCOPE, a prospective observational study of HIV-infected individuals.
On May 22, Hoh received the Lloyd Holly Smith Award for Exceptional Service to the School of Medicine, one of the university’s most prestigious awards. Established in 2000, the award is named for Dr. Lloyd H. (Holly) Smith Jr., chair of medicine and associate dean for 35 years, who passed away on June 18.
In an email interview, Hoh spoke about her interest in HIV cure research, the SCOPE study, and the obstacles that stand in the way of a cure.
What made you choose dietetics as a career?
I was 18 and heading towards university as an undeclared major when my father died from massive cardiac arrest. The fact that he had all the classic symptoms for heart disease (overweight, diabetes, etc.) was a wake-up call. I wanted to learn whatever I could about preventative health. While science was never my thing in high school, I was exposed to a fantastic science curriculum at University of California, Berkeley (UC Berkeley), and a new world opened up. UC Berkeley had an excellent program for nutrition and dietetics, which fit my interests perfectly.
How did you learn about the program at Ward 86 (the HIV clinic at San Francisco General Hospital), and what was your role there?
Marc Hellerstein, one of my professors at UC Berkeley, was also on faculty at UCSF. He needed a dietitian to help with a UCSF research study on smoking and metabolism. I began working with Marc in the early 90s assuming it would be a short-term gig. Around that time, Marc was asked to start a Metabolic Clinic at Ward 86 to address HIV-associated wasting. This was in the pre-protease-inhibitor era when wasting syndrome (severe weight and muscle loss) was a devastating issue. I was doing nutrition counseling and body composition analysis. Marc started clinical trials on anabolic steroids, growth hormones, and nutritional supplements. Those studies were attempting novel therapies to help AIDS patients retain muscle mass and quality of life. I didn’t realize it at the time but it was essentially boot camp training for translational research.
I understand Dr. Steven Deeks made a case for you to join his team. What did he say to convince you?
Rebecca Hoh and Dr. Steven DeeksIf you’ve met Steve, then you know he is a hard person to turn down. I initially met Steve in the San Francisco General Hospital (SFGH) research unit where he was collaborating with Marc on a project. Steve was starting studies looking at ART (antiretroviral therapy) drug resistance and a new observational study called SCOPE. He was building a team and his enthusiasm was hard to resist. Many of the patients I’d grown to know and love over the years at SFGH were joining Steve’s studies and it seemed like a natural fit for me as well.
SCOPE has been billed as one of the most successful clinical studies in the world. Can you describe what it is?
SCOPE began in 2001 as a five-year observational cohort looking at the long-term effects of HIV. Seventeen years and 2,000 participants later, we’re still here.
What SCOPE does is to provide specimens and data to HIV researchers who wouldn’t otherwise have access to clinical specimens – essentially it’s a bridge between the clinic and basic scientists. It’s team science at its best.
I work with a team of study coordinators to carry out SCOPE and its nested projects. Essentially we are scientific event planners – we decipher scientists’ request for clinical specimens, identify patients who may be eligible and interested in participating, and then carry out the study.
Since SCOPE began we have provided over 100,000 samples to over 500 unique investigators. Some of the most exciting work has been in the areas of chronic inflammation and aging, elite control of HIV (providing clues from those who naturally control the virus), and understanding and measuring viral reservoirs. Our ultimate goal is to find a cure for HIV.
The nature of complex trials often leads to a narrower demographic profile of those who can participate – and that in itself is a hurdle to cure.
amfAR’s goal is to develop the scientific basis of a cure by the end of 2020. What obstacles stand in the way?
There are many relevant hurdles in the path to a cure, but as a study coordinator, I have to mention the one our participants must navigate: trial design. Complex logistics, frequent and/or larger blood draws, and visit schedules that cover months, if not years, are major commitments. It’s especially difficult for those who are caretakers or who have inflexible work schedules. Add to that the pressures of living in the San Francisco Bay Area – financial and otherwise. These factors often mean that those most able to commit to an intense study tend to be older, male, and often more financially stable. We are absolutely grateful for anyone who will even consider signing up for a blood draw let alone an intense cure study. However, the nature of complex trials often leads to a narrower demographic profile of those who can participate – and that in itself is a hurdle to cure.
You have been at UCSF for more than 20 years. What are the most challenging and most rewarding aspects of your work?
There are plenty of challenges in academic research – contract delays, staffing shortages, budget headaches — typical red tape. We are lucky to have a small but outstanding administrative team that lets us focus on the science and the patients as much as possible. As for the flip side, working with the research participants is by far the most wonderful part – the time, energy, blood. The research participants are a constant source of motivation for the entire team. Many of the SCOPE participants have been volunteering for studies for over 20 years. They are like a second family.
What does winning the Holly Smith Award mean to you personally and professionally?
Holly Smith is a legend at UCSF. When I got the news that I had received an award named in his honor I was speechless. Knowing that my colleagues nominated me for this award was incredibly special and humbling. Sadly, Dr. Smith passed away just last week (June 18) at the age of 94. While I did not have the opportunity to meet him, knowing the profound impact he made at UCSF certainly increases my desire to help make a difference as well.