Jeffrey N. Martin, MD, MPH
Dr. Martin is associate professor in the Department of Epidemiology and Biostatistics at the University of California, San Francisco (UCSF), and an attending physician at San Francisco General Hospital (SFGH). His clinical training is in internal medicine and infectious diseases, and he attends at the SFGH HIV/AIDS program clinic. He is formally trained in clinical research methods at UC Berkeley, where he earned a master of public health degree in epidemiology. He is currently director of UCSF's NIH-funded, Clinical & Translational Science Institute (CTSI)–sponsored Training in Clinical Research program, in which he serves as director of the UCSF Advanced Training in Clinical Research certificate program and the UCSF master's degree program in clinical research.
Dr. Martin's research methodology is best characterized as clinical or epidemiologic, using epidemiologic methods to derive biologic and clinical inferences. His substantive area of interest is infectious diseases, with a special focus on HIV infection and its complications, notably Kaposi's sarcoma (KS) and Kaposi's sarcoma–associated herpesvirus (KSHV) infection. All of his work is collaborative and multidisciplinary; indeed, all of his projects are built specifically as robust platforms to support a variety of collaborative projects. Because of the compelling nature of the HIV epidemic in Africa, much of his work in the past several years has centered there.
Dr. Martin's principal current domestic research project involves direction, along with Dr. Steven Deeks, of the NIH-sponsored Study of the Consequences of the Protease Inhibitor Era (SCOPE), a 900-subject prospective cohort of HIV-infected adults. SCOPE was established to conduct translational research related to HIV, with the overarching objectives to provide research access to a group of well-characterized, contemporary HIV-infected patients of diverse demographic and clinical status; and methodologic guidance to other researchers in the design and analysis of projects using the cohort's data and biological specimens. As a broad platform, SCOPE has given rise to a large variety of research studies across clinical, virologic, immunologic, and behavioral domains. Since SCOPE's inception, it has provided data or specimens to several hundred investigators nationwide. SCOPE also serves as a fertile training ground, with five faculty members owning NIH K awards that depend on the cohort.
Dr. Martin heads several ongoing projects in Africa. The first is an NIH-funded randomized clinical trial in Kampala, Uganda, of two therapeutic strategies to treat KS. In sub-Saharan Africa, the intersection of the HIV epidemic and endemic KSHV infection has made KS the most common adult malignancy in the region. In patients with KS in resource-rich areas, use of highly active antiretroviral therapy (HAART) often causes regression of KS even in the absence of conventional chemotherapy. However, it is unknown which specific antiretroviral drugs are critical to convey HAART's effect on KS. Data from in vitro systems and animal models suggest that protease inhibitors — originally developed to block the active site of HIV protease — also have direct anti-KS effects. To test this hypothesis, Dr. Martin's multidisciplinary team from UCSF, Makerere University in Uganda, and the CDC is comparing two different HAART regimens among 224 patients with AIDS-related KS. KSHV-specific virologic and immunologic responses after HAART are also being evaluated.
The second project in Africa investigates fundamental epidemiologic aspects of KSHV. Dr. Martin and colleagues are investigating patterns of KSHV seroprevalence, peak age of incident infection, the clinical virology of KSHV (i.e., anatomic sites of viral shedding), and routes of KSHV transmission in population-based samples of children and adults in South Africa, Zimbabwe, and Uganda.
Dr. Martin and colleagues have recently initiated two large cohort studies in Mbarara, Uganda, related to the unprecedented scale-up of antiretroviral therapy. The Uganda AIDS Rural Treatment Outcomes (UARTO) cohort consists of 500 HIV-infected adults who are initiating HAART. Patterned after the SCOPE cohort, UARTO features rigorous research-level questionnaires and biological specimen collection; the focus is translational research. The second study includes all HIV-infected adults — 11,200 currently — at the municipal HIV clinic in Mbarara. In this clinic-based cohort, measurements made during clinical care are captured in an electronic medical record. In both cohorts, the objective is to understand the virologic, immunologic, and clinical outcomes and determinants of patients beginning HAART. The clinic-based cohort is part of a larger network of African HIV clinics whose data are aggregated by the NIH International Epidemiologic Databases to Evaluate AIDS (IeDEA) project. As with the domestic cohorts, the African cohorts are an efficient platform for trainees.