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Where did you perform your internship/residency and what field of specialization did you choose?
I attended the Sackler Medical School of Tel Aviv University in Israel. As part of the hospital rotations I trained at Internal Medicine Department E at the Sheba Medical Center, the largest hospital in Israel. I was captivated by the internal medicine discipline and its complete consideration of the whole patient, and there was no question in my mind that this was the physician I wanted to become. I was drawn to the excellence of Internal Medicine Department E, and to the quality of the people within it, and was lucky to eventually complete my four-year residency there. I was honored to be part of the amazing legacy and group of outstanding physicians on that ward, who educated me as a physician and as a person, and instilled in me the best medical roots possible. From that point on I always feel as though Drs Farfel, Pauzner, Mouallem, and Mayan are walking with me in the hospital halls, no matter where in the world I am. It is an amazing and empowering feeling.
In my internship year, during the rotation in pediatrics, I had a 4-y-old patient with AIDS who was failing antiretroviral therapy with no remaining treatment options. I remember reading day and night about this new syndrome, about this patient’s situation and of the then-new medication stavudine (d4T) that had been approved by the US FDA a few months earlier. Watching the evolution of a recently discovered medical condition and the progress made on it in real-time to advance knowledge and help save lives of patients affected by it, were exciting. This convinced me, perhaps subconsciously initially, of my interest in this virus. During residency, I continued to take care of HIV-infected patients as they would increasingly be admitted. I spent my research time in Prof Jonathan Gershoni’s HIV research laboratory and set up an assay to identify the then recently-described CCR5 delta 32 deletion, which confers resistance to HIV infection, and examined its occurrence in different HIV-infected populations. Our findings of its highest prevalence in Ashkenazi Jews and its effect of a slower progression to AIDS in heterozygous patients with hemophilia were my first exposures to HIV research that greatly augmented my clinical experience and scientific curiosity. The path from there to my interest in an infectious diseases fellowship was paved.
What do you like most about your work as a physician?
I like the personal contact and the ability to help my patients at times when they may be in need. I find that the most important characteristics of a physician are being compassionate, kind, helpful, humble, and confidential, and having the ability to make a difference by giving attention, prioritizing and respecting. As a young doctor in earlier days, when there was less knowledge and more concern, stigma, and prejudice against AIDS, being able to connect with HIV-infected patients and provide high quality medical and personal care to them was very important to me as it reflected those characteristics. Making such special connections with patients, providing this quality of care and making a difference in people’s lives are what I like most about being a physician.
Tell us about the most important stages of your professional career
The first important stage of my professional career was when I decided that I want to become a physician. From the moment of that realization, no other profession seemed as relevant and interesting to me as medicine, and I never looked back.
After completing medical school and internal medicine residency, the next important step in my career was being an infectious diseases fellow at the Sheba Medical Center, under the superb direction and mentorship of Prof Ethan Rubinstein. My time there, working with Dr Itsik Levi and Dr Bina Rubinovitch was rewarding, educating, and motivating. After four months, Prof Rubinstein and Dr Jonathan Schapiro offered me the opportunity of a research internship at Stanford University to study HIV drug resistance. This opportunity proved to be a major turning point in my professional career. Being a post-doctoral fellow at Stanford allowed me to devote full time to research in an outstanding academic environment, and to work with Drs David Katzenstein and Bob Shafer, who mentored my work. Learning about HIV drug resistance from the perspectives of multidisciplinary fields such as bioinformatics, statistics, molecular evolution, and virology supplemented my clinical knowledge and emphasized for me the important coexistence of research and clinical care. I realized that the two are mutually inclusive. While clinical work provides the personal relationship with patients and the context in which findings are implemented, research has many attractive components, mainly the ability to pose your own inquiries, and discover answers to clinical questions. During my medical school and residency, research was limited due to intense clinical demands, but at Stanford it was the other end of the spectrum—doing a lot of research with no clinical work. Wanting to combine both is what led me to Brown University.
Being a clinical infectious diseases fellow at Brown enabled me to return to clinical medicine, and helped to appreciate what an important part of my life it is. The flexibility of the fellowship program under the directorship and support of Drs Timothy Flanigan and Karen Tashima allowed me to continue my research, write grants, and travel to execute them, all while having a busy clinical fellow’s schedule. This balance was not easy, but extremely fulfilling.
Joining the Miriam Hospital and Brown University Faculty was the next important step in my career, which I currently enjoy. Attending to outpatients and inpatients as well as working internationally and collaborating with exceptional investigators at outstanding sites such as the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya, YRG-Care in Chennai, India, the University of Ghana in Accra, Chulalongkorn University in Bangkok, the Chinese Centers for Disease Control in Beijing, and more, is gratifying. The ability of my research findings to have an instant impact on patient care is what motivates my work. For example, our research in western Kenya on monitoring antiretroviral treatment in HIV-infected patients indicated that the globally-used World Health Organization guidelines have high rates of misclassification of treatment failure, and led to implementation of HIV viral load testing as a new standard of care at AMPATH. This finding prevented unnecessary switches to costly medications and accumulation of HIV drug resistance as a result of false classification of treatment failure. This is a great demonstration of the importance of combining the knowledge of clinical care with research.
When and where did you start your own lab?
A few years after I arrived at Brown University, after I finished my clinical infectious diseases fellowship and got an NIH RO1 grant, I was ready to add a laboratory component to expand my research. I was excited to receive laboratory space at The Miriam Hospital, where I started my own lab. I could not have done this without the support of Dr Timothy Flanigan who, together with Dr Bharat Ramratnam, first recruited me to Brown and the Lifespan/Brown/Tufts Center for AIDS Research. I also appreciate the continuous support of Dr Lou Rice, my Department Chair; Dr Lefteris Mylonakis, my Division Director; Drs Charles Carpenter and Susan Cu-Uvin, the Brown/Lifespan/Tufts Center for AIDS Research Directors; and Dr Jane Carter, the Director of the Brown-Kenya Program.
What areas or topics does your lab currently focus on and who are your partners?
HIV is a daunting pandemic, mostly prevalent in resource-limited settings. It has devastated children, adults, communities, societies and countries who continue to suffer under its burden. The HIV/AIDS pandemic in western societies is in many ways different from the pandemic in resource-limited settings. One aspect of this contrast is derived from the enormous diversity of HIV. Multiple viral variants, termed subtypes and recombinant forms, predominate in different geographic regions. The HIV subtype mostly common in the US, Europe, and Australia is subtype B and therefore most drug design research has been conducted on this subtype in those settings. Similarly, most research and knowledge on drug resistance, the major global hurdle for sustainable HIV treatment success, has also been derived from subtype B. Despite its predominance in the western world, subtype B only comprises about 10% of the global pandemic. The most common subtype in the world is subtype C, prevalent in South Africa and India; subtypes A and D predominate in eastern Africa; AG recombinants are the main variants in western Africa, and so on. This discrepancy, or paradox, of much knowledge about a small proportion of the global pandemic, and not enough information on other fractions, is the focus of my research. Do physicians need to take the specific HIV subtype into account in clinical care? If so how? Why? How does this affect resistance evolution and patient care? Such questions form the rationale for my research.
Some specific current projects in my lab include:
(1) Examination of drug resistance evolution in HIV-infected adults and children who start or are failing antiretroviral treatment in global settings such as the US, Kenya, Ghana, Ethiopia, Cambodia, Thailand, China, India, Cape Verde, and Israel. Such work improves understanding of global HIV drug resistance and patient care. Dr Austin Huang in my lab has been a big part of this research, as well as my multiple national and international collaborators.
(2) Investigations of similarities and differences in the evolution of drug resistance mutations among different body compartments such as blood and genital secretions, which have impact on resistance transmission.
(3) Phylogeny and molecular epidemiology to investigate HIV transmission networks and examine ways to disrupt them, work I do with Dr Phil Chan.
(4) The interaction among different HIV genes to examine their impact on resistance evolution, work I do with Dr Mia Coetzer in my lab.
(5) Development of methods to better monitor HIV-infected patients in resource limited settings; work in collaboration with Dr Joseph Hogan, Dr Tao Liu, and Allison DeLong from the Brown Center for Statistical Sciences.
(6) Development of cheap and simple assays and methods to detect drug resistance and their incorporation into point of care devices that can be used to improve patient care in resource limited settings, work in collaboration with Dr Anubhav Tripathi from the Brown School of Engineering, and Dr Sorin Istrail from the Brown Center for Computational Molecular Biology. These and other areas of my research are translated to improvement of HIV patient care worldwide.
Who were your mentors?
I was lucky to have several great mentors throughout the years, and I am grateful to each and every one of them. Several of them stand out: my mentors at the Internal Medicine E Department including Zvi Farfel, who was the head of the department during my residency, a commendable clinician with main interests in hyperkalemia, hypoparathyroidism, hypertension, and hypoaldosteronism among others; Rochale Pauzner, the department vice-chair with whom I spent much time, who was an expert in systemic lupus erythomatosus and other autoimmune rheumatologic diseases; Meir Mouallem, a brilliant clinician who also won Israel’s prestigious physician award for his skills and abilities; and Haim Mayan, who is now the head of the department, and an outstanding clinical pharmacologist. Jonathan Gershoni from Tel Aviv University lit the HIV research spark in me, and taught me to love HIV research. I will always admire his personality, laboratory and management skills, sense of humor and friendship, as well as his outstanding scientific understanding of HIV. Ethan Rubinstein from the Sheba Medical Center Infectious Diseases Unit, an expert in multiple infectious diseases areas such as antimicrobial resistance and endocarditis, opened many doors and opportunities for me and set an excellent example of an infectious diseases physician–scientist. Bob Shafer at Stanford taught me the basics of being a serious researcher, and his work ethic and drive still guide me in my research today. His establishment of the Stanford HIV Sequence Database, a global resource for HIV resistance understanding and analysis, and his deep and profound understanding and knowledge of HIV drug resistance were educating and inspiring. David Katzenstein from Stanford, my mentor and friend to this day, taught me what it means to be a good mentor, and the thrill, challenge, and importance of conducting HIV research where it’s most needed: in resource-limited settings. His brilliant mind, boundless creativity, incredible knowledge of HIV, endless support, and warm personality will always be inspirational and stimulating. Tim Flanigan of Brown, with his flexibility, wit, energy, amazing character, and unlimited support continues to be my mentor and friend. Lastly, my most important mentor is my father, who has mentored me throughout my life and made me who I am today.
What makes a good mentor?
Looking back at all my mentors, I think that the most important quality of a good mentor is first and foremost being a good person; more specifically, being kind, respectful, and approachable, for both professional and personal issues, and looking after mentees’ needs while helping them fulfill their goals. Mentorship is and should be demanding, and when done right requires a lot of time, dedication, and motivation. This is particularly true when mentoring remotely, such as in far-away countries. An important part of good mentorship is the mentor’s experience and expertise, which affect the structure and content of the interaction with mentees. Thought must be given to context, what is most helpful to the mentee, and how ideas are conveyed. My experiences with past mentors have taught me to value being a mentor and the mentoring process and to not take them for granted. My best and most appreciated mentors remain my friends to this day, who I go to for advice, share thoughts and concerns with, and continue to learn from as I mature as a mentor.
What was your most significant scientific accomplishment?
I think it was my early understanding of the importance of concentrating on drug resistance in multiple HIV subtypes around the world. At the time that I started to be interested in this line of research, some top researchers in the field of HIV drug resistance did not believe that this was an important topic to invest time and effort in. I believe that my work with David Katzenstein and the establishment of the international HIV Non-Subtype B Working Group with some of the most prominent global investigators in that area, and its initial output—a publication in PLOS Medicine—paved the way for worldwide interest in this topic. I am proud that this is now a high global priority.
What do you do for fun?
I love spending time with my wife, two daughters, and dog, something that I always look forward to and want more of. I love all aspects of basketball. I love listening to music, and playing the piano and guitar. I enjoy theater, from local productions to large scale musicals. I love to travel all over the world, mostly back home to Israel, to visit my dad and my extended family that I miss so much.
What advice would you give to junior people entering the field?
Work hard and develop the skills you need; get involved in research that you are or can become passionate about; look for a great group of people to work and collaborate with; find supportive and wise mentors; try to avoid distractions and don’t lose your focus; and finally, strive to have a loving and supportive family, which is the foundation for everything.
About Dr Rami Kantor. Dr Kantor graduated as an MD from the Sackler Medical School of Tel Aviv University in Israel, where he also got his Masters in postgraduate internal medicine. He performed his internal medicine residency at the Internal Medicine Department E in the Sheba Medical Center in Israel, his postdoctoral HIV research fellowship at Stanford University in CA, and his postdoctoral clinical infectious diseases fellowship at Brown University in RI. He joined the Department of Medicine, Division of Infectious Diseases Faculty at Brown as an Assistant Professor in 2005, while still an Infectious Diseases fellow, and was promoted to Associate Professor of Medicine in 2011, his present position. Dr Kantor serves on the editorial board of the Journal of the International AIDS Society and of Virulence. He served on several NIH grant review study sections and was recently elected to membership in the NIH AIDS Clinical Studies and Epidemiology Study Section (ACE). He is a member of the AIDS Clinical Trials Group, the WHO HIV Resistance Network and the TREAT Asia Studies to Evaluate Resistance and Quality Assessment Scheme Steering Committees. Dr Kantor’s research focus is on HIV diversity, treatment monitoring, molecular epidemiology, and the evolution of drug resistance to antiretroviral medications, particularly among diverse HIV variants that predominate globally. His research is multidisciplinary and incorporates bioinformatics, sequence and phylogenetic analyses, databases and data management, clinical and basic science research. He directs the Drug Resistance Research Laboratory at The Miriam Hospital and is also a clinician and attends to HIV-infected outpatients and inpatients.
Dr Kantor (far left), his daughter Shir (far right on the bench), Dr Lameck Diero, Dr Kantor’s close collaborator and Chief of Medicine at Moi University in Eldoret, Kenya (far left standing, in red and white stripe shirt), Emmanuel Kemboi, Dr Kantor’s research assistant in Kenya (far right), and his extended family and friends in his rural village in Kenya.
