I am Board Certified in Neurology. After my Neurology training, I completed a fellowship in Infectious Diseases. The focus of my research is on infections of the nervous system, and in particular syphilis and HIV. We began a study of cerebrospinal fluid abnormalities in patients with syphilis in1996. Broadly stated, the goal of the project was to identify which patients with syphilis are at increased risk for neurosyphilis, to identify means to better diagnose neurosyphilis in HIV-infected patients, and to determine the best ways to assess the success of neurosyphilis treatment. We were able to show that easily identifiable clinical factors, including high serum rapid plasma reagin (RPR) titer and whether an HIV-infected patient was taking antiretrovirals, influence neurosyphilis risk. We also showed that the infecting Treponema pallidum strain type and polymorphisms in host toll like receptor genes increase neurosyphilis susceptibility.
We are currently conducting a trial aimed at determining whether lumbar puncture early in syphilis with treatment decisions based on cerebrospinal fluid findings improves serological, cognitive and functional outcome in HIV-infected and -uninfected patients with syphilis. In the laboratory, we are exploring genetic risks for neurosyphilis using whole exome sequencing. We are also examining differences in host macrophage and T. pallidum-specific opsonic antibody function in patients with uncomplicated syphilis and neurosyphilis.
I participate in clinical research studies on neurological complications of HIV conducted by the UW AIDS Clinical Trials Unit, which is part of the national AIDS Clinical Trials Group. These studies address the pathophysiology of HIV-associated neurological diseases, as well as treatment and prognosis. I have been particularly interested in the role of CNS penetration of antiretrovirals in treatment of HIV-associated cognitive impairment and in the impact of co-infections (like syphilis) on cognitive impairment in HIV-infected individuals. With Dr. Ann Collier, I am local co-PI of the UW CHARTER (CNS HIV Antiretroviral Therapy Effects Research) site. CHARTER is a multicenter, longitudinal prospective study of neurological, neuropsychological and neuroimaging abnormalities in HIV-infected individuals.
Clinically, I have cared for HIV-infected people with neurological problems since 1988. I also attend on the Neurology consult service at Harborview.
Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, e7. Scheld WM, Whitley RJ, Marra CM (Eds). Infections of the Central Nervous System, Fourth Edition. Philadelphia. Lippincott, Williams and Wilkins. 2014.
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