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Susan Graham, MD, MPH, PhD

  • Assistant Professor, Division of Allergy and Infectious Diseases, Department of Medicine
  • Assistant Professor, Department of Global Health
    Adjunct Assistant Professor, Department of Epidemiology
  • University of Washington

Dr. Graham earned a medical degree from McGill University in Montreal, Canada, a master's degree in public health from Boston University in Boston, Massachusetts, USA, and a PhD in clinical epidemiology from the University of Toronto in Toronto, Canada. She holds Visiting Scientist appointments at the University of Nairobi and the Kenya Medical Research Institute.

Dr. Graham is currently an Assistant Professor of Medicine and Global Health and an Adjunct Assistant Professor of Epidemiology. She has been in the UW Department of Medicine since 2003, when she came from Brigham & Women's Hospital to begin fellowship in Infectious Diseases and a career in HIV research. She has authored or co-authored 50 peer-reviewed publications, including 17 first-author and 7 senior-author publications in such journals as the Journal of Infectious Diseases, AIDS, Journal of the Acquired Immunodeficiency Syndrome (JAIDS), and PLoS One. In addition, she directs the University of Washington School of Medicine's Global Health Pathway and is the Track Director for the University of Washington's concurrent MD-MPH program in Global Health. She also directs the annual "Principles of STD/HIV Research" course, with co-director Rachel Winer.

Since joining UW Kenya Research Program in 2003, Dr. Graham has developed two main research areas: (1) HIV treatment and prevention, with a focus on marginalized populations; and (2) HIV pathogenesis and disease progression.


HIV Treatment and Prevention

During fellowship training, Dr. Graham worked in Mombasa, Kenya to investigate the impact of antiretroviral therapy (ART) on genital HIV-1 shedding in women. She developed and launched the ART program for the Mombasa female sex worker cohort (one of the first ART programs on the Kenyan coast), and was awarded a K23 grant in 2006 to study genital HIV-1 shedding among women starting second-line ART. In addition, she led the field work on an R21 grant to study male genital HIV-1 shedding.

Dr. Graham also works in collaboration with Dr. Eduard Sanders and colleagues at the Kenya Medical Research Institute (KEMRI) in Kilifi. Work at KEMRI originally focused on HIV acquisition in female sex workers, but soon also included work on men who have sex with men (MSM). Dr. Graham developed an HIV-1-seropositive cohort at KEMRI, which is currently the largest cohort of HIV-positive MSM in Africa. In the context of this work, she has published many papers on HIV and other sexually transmitted diseases (STD) in adults reporting high-risk sexual behavior. These studies revealed that MSM in Kenya had a very high HIV-1 prevalence (24.5%) and incidence (8.6 per 100 person-years), as well as high STD rates. This high HIV risk resulted in large part from the failure of African HIV programming to identify and target these men as a risk group. Dr. Graham has since developed a focus on treatment access for HIV-positive MSM, and is currently conducting an NIMH-funded R34 award that supports a 3-year project to identify barriers and facilitators to adherence in MSM, develop an intervention using provider and peer support, and test that intervention in a small RCT.

Additional work by Dr. Graham and her KEMRI collaborators has focused on diagnosis of acute HIV infection in young adults presenting to pharmacies and health centers with fever. Using the P24 antigen test, they have reported a prevalence of acute HIV infection was equal to that of malaria in this population (1.2% for each condition). The KEMRI team has established a program to connect newly diagnosed persons with acute or prevalent HIV infection to care and treatment, and aims to investigate the potential impact of this program on HIV transmission in Kenya, as well as its cost-effectiveness.

HIV Pathogenesis and Disease Progression

Dr. Graham also has a long-standing interest in HIV-1 pathogenesis, disease progression, and the risk of adverse outcomes. She recently completed a CFAR New Investigator Award to investigate biomarkers of endothelial activation in patients with HIV-1 infection and related comorbidities including Kaposi's sarcoma. Her work with her colleagues demonstrated that levels of the cellular adhesion molecules ICAM-1 and VCAM-1 both increase after HIV-1 acquisition, and that angiopoietin levels are dysregulated (i.e., higher ANG-2, lower ANG-1) as disease progresses. Moreover, antiretroviral therapy decreases these endothelial activation biomarkers, but does not fully normalize endothelial function.


Selected Publications


Graham SM, Mugo P, Gichuru E, et al. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in Coastal Kenya. AIDS Behav. 2013; 17(4): 1255-65.
PubMed Abstract


Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, Peshu N, van der Elst EM, Price MA, McClelland RS, Graham SM. High HIV-1 incidence, correlates of HIV-1 acquisition, and high viral loads following seroconversion among MSM. AIDS. 2013; 27(3): 437-46.
doi: 10.1097/QAD.0b013e32835b0f81.
PMID:
23079811
PubMed Abstract


Graham SM, Holte SE, Dragavon JA, et al. HIV-1 RNA may decline more slowly in semen than in blood following initiation of efavirenz-based antiretroviral therapy. PLoS One. 2012; 7(8): e43086. doi: 10.1371/journal.pone.0043086.
PMID:
22912795
PLoS ONE Abstract


Graham SM, Jalalian-Lechak Z, Shafi J, et al. Antiretroviral treatment interruptions predict female genital shedding of genotypically resistant HIV-1 RNA. J Acquir Immune Defic Syndr. 2012; 60(5): 511-8.
doi: 10.1097/QAI.0b013e31825bd703.
PMID: 22592588
PubMed Abstract


Graham SM, Masese L, Gitau R, et al. Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy. Sex Transm Infect. 2011; 87(2): 114-7.
PMID:
20980464
PubMed Abstract


Graham SM, Masese L, Gitau R, et al. Antiretroviral adherence and development of drug resistance are the strongest predictors of genital HIV-1 shedding among women initiating treatment: a prospective cohort study. J Infect Dis. 2010; 202(10): 1538-42.
PMID:
20923373
PubMed Abstract

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