UH Special Immunology Unit Treating the Whole Person

Advancing the discovery of HIV 40 years ago and the science of tomorrow’s care

UH Clinical Update | July 2021

Patients receive heartfelt compassion and the latest scientifically advanced treatment at the UH John T. Carey Special Immunology Unit (SIU) — a place where HIV-positive patients get life-giving treatment and are offered a healthcare provider family dedicated to their care.

When the AIDS pandemic was identified 40 years ago, first in the gay population, UH researchers engaged early in the effort to understand this deadly disease.¹  Previously healthy persons would develop serious infections and unusual malignancies that were otherwise only seen in persons with recognized immune deficiencies. The first infections might respond to treatment, but the course of disease was unstoppable with progressive weight loss, recurrent infections and death. Socially isolating stigma just made these patients’ lives worse.

In 1982, Oscar Ratnoff, MD, at University Hospitals, asked Michael Lederman, MD, to help him sort out what might be responsible for the early cases of AIDS among hemophiliacs.  Dr. Lederman’s studies revealed AIDS-like immunological abnormalities in hemophiliacs who appeared to be healthy, but who had been treated with anti-hemophilic clotting factors that were pooled from the blood plasmas of thousands of different donors. This work indicated that the AIDS agent (that had still not been identified) could be transmitted through blood products.

Soon after, the faculty of University Hospitals’ Division of Infectious Diseases took on the responsibility of providing care to the growing number of AIDS patients who were arriving for care in Cleveland. Dr. Lederman applied for the first NIH grants to fund AIDS research here and with this funding established the AIDS Clinical Trials Unit to study new treatments for this deadly disease. Dr. Lederman and two young Infectious Diseases fellows, John Carey, MD, and Janet Arno, MD, opened the Special Immunology Unit to provide sustained outpatient care to persons with HIV infection and AIDS.

“We shied away from calling it the AIDS Clinic because of the surrounding stigma, and although a bit coy, ‘Special Immunology Unit’ seemed practical,” said Dr. Lederman.

Much progress has been made on AIDS and HIV since then. HIV is no longer deemed a death sentence with an unwavering progression to AIDS. People living with HIV now have a life expectancy near that of those without HIV. New drugs keep the amount of virus in the blood at an undetectable level preventing replication. Therefore, no resistance to the medication can occur, so the drugs continue to work as long as people take them. Furthermore, when the virus is undetectable, it can not be transmitted to others. Current HIV medications combine three drugs in one pill daily, instead of the complicated drug cocktail that was originally administered.

Barbara Gripshover, MD, Medical Director of the John T. Carey SIU; and Professor of Medicine, Case Western Reserve University School of Medicine, said, “The new drugs are more potent and easier to take.”

Also, there is now research into long-lasting injectable forms of antivirals, including cabotegravir and rilpivirine. While monthly injections are now available, soon there will be a three- or six-month injections for HIV without daily pills, according to Grace McComsey, MD, Vice President of Research and Associate Chief Scientific Officer, UHHS, Director, UH Clinical Research Center and Dahms Clinical Research Unit, Rainbow Babies & Children's Foundation John Kennell Chair of Excellence in Pediatrics; Division Chief of Infectious Diseases, UH Rainbow Babies and Children’s Hospital, and Professor of Pediatrics and Medicine, School of Medicine. She believes this will be a game changer for young HIV patients who are “sick of taking daily pills, and have ached for a good quality of life similar to other adolescents. Taking daily pills is a constant reminder of a stigmatizing virus that many have had since birth.”

UH SIU not only offers HIV treatment and PrEP (pre-exposure prophylaxis, a daily medication to prevent HIV infection in persons at high risk of acquiring it), but also provides care for the whole person. SIU patients have on-site specialized care through nutrition, cardiology, Ob/Gyn and psychiatry, as well as mental health counseling, social work services and support groups. This comprehensive care team is supported by Ryan White funding, which ensures all patients access to care regardless of ability to pay.

“We have an amazing team at the SIU, dedicated to providing total care for this population,” said Dr. Gripshover. “We have support groups, yoga and a walking group. We are trying to address the loneliness and stigma that can prevent patients from engaging in care.

“Also, we have the whole team in one spot, not in several locations. We take care of our patients like family. We think of them like that, and patients say that about us too.”

Dr. McComsey agreed, and added that several patients who moved out of state came back to the SIU for their care, even when it means traveling long distances.

The Case Western Reserve University/University Hospitals AIDS Clinical Trials Unit (ACTU) was established in 1987 and is a founding unit of the AIDS Clinical Trials Group, the world’s largest network of AIDS-related treatment clinical trials. Dr. McComsey said a very important part of each SIU patient visit is the opportunity to participate in research trials.

“Patients say, ‘I like to come here because I think you care about me as person, and you listen to me,” she said. “Research or clinical care, they feel we care about them as a human being. Research in HIV is what transformed this disease from a fatal infection to a chronic illness, like diabetes and heart disease. In addition to giving patients the best available therapies, we show them how to stay healthy with vitamins, nutrition, exercise and healthy living — not just take that pill and we will see you in six months. We optimize their quality of care. Research studies are about making life better.”

The trust between patient and the healthcare provider at SIU has contributed to Dr. McComsey’s success in HIV research. Current areas of interest involve inflammation processes in HIV cardiovascular disease, fat alternations or lipodystrophy in HIV patients as a result of medications, gut dysfunction and enhanced inflammation, and addressing disparities in HIV care in patients of color.

For a list of current trials open for enrollment, visit clevelandhiv.org.

1. Lederman, M. AIDS in the heartland — hemophilia was the harbinger of things to come. J Acquir Immune Def Syndr 2021; 86:517-522.