I am very interested in the manner in which Hepatitis C Virus (HCV) injures liver grafts after transplantation. Along with my collaborators Drs Laskus and Rakela we have been making inroads into the mechanisms by which HCV behaves after liver transplantation. We have described the effect of viral genotypes on the course of post-transplantation hepatitis, the behavior of the virus when two viral strains are present in the recipient of a transplant and extra hepatic infection with HCV. We have pioneered the effort with respect to central nervous system infection with HCV in this patient population. I have obtained NIH funding to study the importance of viral quasispecies development in two viral regions during the course of the post-transplantation period.
My clinical practice has delved in to the more practical issues of post liver transplantation HCV infection, where I am an active participant in several trials of antiviral therapy in this clinical setting. We have published several articles that deal with the challenges of treating HCV in this patient population.
The second area of interest is the effect of the immunosuppressive regimen on viral behavior after liver transplantation. Collaborating with investigators from 15 centers in the United States, I hope to characterize the effect three different regimens of immunosuppresion (anti-rejection medications) have on viral behavior. We are actively studying the virus from 312 patients randomly assigned to one of these three regimens and followed long-term. The long term objective is to formulate optimal immunosuppression for patients transplanted for HCV-related disease.
The third area of interest is the hypothesis that HCV infects the brain in patients who do not have immune impairment. I have funding to study the neuropsychiatric, radiological, immunological and virological characteristics of patients infected with HCV. My study aims to link well described changes in this population of patients with evidence of CNS infection. I am very excited about the possibility of developing this important area of research.
In addition to these main areas, I have active interests in the following areas in hepatology:
- Portal hypertension, particularly the management of variceal bleeding and ascites
- Hepatocellular carcinoma, particularly in combination with HCV
- Hepatitis B virus after liver transplantation