March 22, 2023
Elijah Paintsil, MD, is Professor of Pediatrics, of Pharmacology, of Epidemiology and of Management at Yale School of Medicine where he serves as Chief of the Section of Pediatric Infectious Diseases & Global Health, Department of Pediatrics, and the Director of Pediatric AIDS Program at Yale-New Haven Hospital. He completed medical school in his native Ghana, residency at Lincoln Hospital in New York and fellowship training in pediatric infectious disease at Yale. Dr. Paintsil is both a laboratory-based and clinical investigator with a major interest in understanding the determinants of individual differences in response to antiretroviral therapy (ART), particularly, the effect of ART on mitochondrial function and how that affects HIV comorbidities such as metabolic syndrome and cardiovascular disorders.
Dr. Paintsil is a member of the Society’s Board of Directors, and also serves on the Pediatric Scientist Development Program Steering Committee, the Leadership of the HHS Panel on the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children, and is a consultant to Africa CDC on their COVID-19 mitigation efforts. Dr. Paintsil devotes significant professional effort to training and capacity building. During his 18 years on the faculty at Yale, Dr. Paintsil has mentored over 40 trainees at the undergraduate, masters, doctoral, and post-doctoral levels, and junior faculty.
Why Pediatric ID? First, when I came to the United States, I became intrigued by the concept of physician scientists. Back in Ghana where I went to medical school, the MDs saw patients and the PhDs did research. It was when I came to the United States for residency that I realized the career path of physician scientist was available and I began to seriously work toward that after residence, which led me to infectious diseases.
I had left home at the early stages of HIV, i.e., the first decade of the pandemic. At the time, there were profound inequities in access to ART and diagnostics. If you look at it, the global north, beginning in the late 1980s and early 90s had access to ART, but in most countries in Africa, home to over two-thirds of people living with HIV, ART would become available in the early- to mid-2000s. I saw firsthand how ID physicians at the time were contributing to discoveries in HIV diagnostics, treatment, and management approached. That really excited me. I thought, ok, you want to be a physician scientist and these infectious diseases physicians are really driving the response to the disease that was set to decimate my people in Africa and it wasn’t a difficult sell to me.
Where have you taken your ID focus? I started my career deciding to do lab research during fellowship. I began working on drug-resistant HIV and its evolution. Later, I went into side effects of the drugs used in treatment. My mentor had contributed to the discovery of some of the nucleoside analogues that are used in HIV and at the time, the side effects were unbearable to patients. As a clinician in the lab, I decided to focus on the effects of these drugs and zoomed in to look at the mitochondria. At the time it was believed that ART-induced mitochondrial dysfunctional was responsible for the side effects. My research was translational, focusing on finding what these drugs were doing to the mitochondrial function. Now, I’ve been working on these drugs effects on mitochondria and how it leads to side effects we see, particularly metabolic syndrome and cardiovascular disorders.
When I started my career, there weren’t many lab support systems in Ghana to support my type of research, so I tended to do more clinical research there. But once one of the first pediatric HIV clinics was set up in Ghana in 2004, I decided to piggyback on them to look into treatment outcomes in children. Since 2007, I have been more interested in building research capacity on the continent. I look at if I had the opportunity to do research in medical school or had mentors who were doing research while I was in medical school there, I probably would not have come to the U.S., because there are a lot of infectious diseases in Africa. My passion has become to create research capacity in Africa.
What is a recent development in pediatric ID you are working on? I have a program where I bring Ghanaians to New Haven in the summer where they stay for two to three months and in some instances up to a year being mentored by Yale professors in the lab. And I also have an HIV research training grant funded by the Fogarty International Center to train graduate students and postdocs in research into HIV comorbidities in Ghana. The program in Ghana has been expanding. We have other universities, in Saudi Arabia, Jamaica, Brazil, China, Uganda, Singapore, that have been added. We are beginning to build a network and make it possible for program participants to meet people from all over the world while in New Haven. It has been a wonderful exchange. In many cases, their home countries are being plagued by the same disease conditions. One nation may be advanced compared to another, but they are able to share knowledge and technology with one another.
One thing I’m excited about is the translational research we are doing now Africa, in Uganda and Ghana, where we really examine what the side effects of these drugs are doing to the mitochondria. We now believe the high prevalence of metabolic syndrome in people living with HIV, one of the contributing factors, could be the antiretroviral drugs causing mitochondria dysfunction. In normal people, this should be developed in the fifth decade of life, but it starts earlier in people living with HIV .
In infectious diseases, one hypothesis begets another. We started with just the side effect and thought the drug could be the culprit and found the relation to the mitochondria. Now we are finding mitochondria dysfunction could be the potential etiopathogenesis of this metabolic syndrome. What a gift to pediatric HIV specialists. That is something I have been passionate about, that after 17-18 years I am now able to really bring lab-based research to Africa. I’d dreamed about this so many years ago.
What do you enjoy most about being a PIDS board member; what keeps you renewing your Society membership? First and foremost, it is the vision and mission of the Society. It’s how passionate we all are on all things infectious disease and in helping children. Usually, children are forgotten or a second thought. But for a society to put all its energy in reaching and serving children is golden. Pediatric infectious diseases is a subspecialty where you don’t have to preach equity to them. Our Society has taken a lead in equity, we were doing it even before the concept of diversity, equity and inclusion took hold. We have been dealing with diseases that affect the broad swath of humanity from the start, whether it is the underserved, the well-served, or the privileged in the world. I see in our Society that we embody that.
Those pediatric ID people who came before us took on vaccines in children that largely affect the global south, but people here worked hard to address those diseases. We have been for equity and inclusivity from the start and I love that. I came to the board to continue that sort of work and ensure we continue to advocate for equity, diversity, inclusivity for all the children in the world.
Also, networking and collaboration of the society is special. I am a member of several societies, this one is like a family that you want to be with. That’s what keeps attracting me to be part of PIDS. I am currently a section chief of ID, and seeing how we can address this issue of getting people into pediatric ID. The work of the board to create policies and strategies to keep people excited about our specialty, . trying to get more interest in our students, residents, even looking at the high school level. COVID has been a primer to those of us in ID to drum up interest. If we don’t use the momentum COVID has given us it would be a lost cause.