Robert Grant , MD, MPH (Emeritus)

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Robert Grant, MD, MPH (Emeritus)

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Member, CFAR Scientific Council
Professor, School of Medicine
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Biography

Dr. Grant believes that clinical and public health practice inspires the best research. His goal is to find ways for people to breath more easily, and to end HIV transmission and disease. His work with HIV started in 1983 with the epidemic when he was a graduate student in epidemiology at UC Berkeley. With the completion of his work pioneering HIV pre-exposure prophylaxis (or PrEP) in 2014, he pivoted to focus on the underpinnings of the epidemic, including stigma, trauma, injustice, addiction, and depression. His current clinical practice is on pulmonary medicine, and how breathing intersects with emotional well being. The next phase of his research focuses on novel transformative interventions for depression and anxiety, including ketamine and MDMA assisted psychotherapies.

Dr. Grant has had a clinical practice in pulmonary and critical care medicine from 1994 to the present, including at Zuckerberg San Francisco General Hospital, San Francisco Veterans Administration Medical Center, and UCSF Health. He started the Sexual Health Improvement Project at UCSF in 2014; this was the first clinical service at UCSF to offer HIV preexposure prophylaxis. He served as the Chief Medical Officer of the San Francisco AIDS Foundation from 2014 to 2018, where he oversaw the initiation of the largest PrEP service in San Francisco, HIV treatment initiation in a sexual health clinic, and HCV treatment linked with a needle exchange site. The SFAF PrEP service is innovative in being rooted in a community based organization, led by nurses, pioneering same day PrEP initiation (and later, same-day HIV treatment initiation), and offering education for non-daily or 2-1-1 PrEP dosing.

Dr. Grant has served as an advisor for laboratory medicine, antiretroviral therapy, and pre-exposure prophylaxis to the CDC, the FDA, and the WHO. He helped develop the WHO recommendation for PrEP (AIDS 2016) and he drafted the WHO PrEP Implementation Tool Kit in consultation with hundreds of experts and stakeholders around the world (https://www.who.int/hiv/pub/prep/prep-implementation-tool/en/). He co-founded a ketamine assisted psychotherapy practice called "Healing Realms" in 2017, and now serves on the board of directors of the American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP). He is a mentor in the California Institute of Integral Studies Certificate Program in Psychedelic Treatment and Research (CIIS CPTR).

Key findings from Dr. Grant's research include the following:

1. Conceptualization and estimation of transmissibility: Dr. Grant developed the concept of transmissibility (now denoted with "beta") and developed a method for estimating transmission of HIV per sexual contact and per sexual partner using epidemiological data (JID 1987). This parameter formed the basis of a generation of mathematical models of infectious epidemics.

2. Diagnostic innovations that guide therapy: Dr. Grant was the first to demonstrate that oral fluid could be used for HIV diagnostic antibody testing (CDLI 1996). He later conducted research that led to the first sequence based assay for drug resistance (or any other condition) to be approved by the FDA (J Clin Micro 2003).

3. High viral load in nonpathogenic SIV infections: Dr. Grant's laboratory discovered a null allele of CCR5 in the natural host of simian immunodeficiency virus. The host genotype was associated with viral load in nonpathogenic infection (Current Biology 1998).

4. Drug resistant HIV has diminished clinical consequences: First case report of transmission of protease inhibitor resistant HIV-1 (NEJM 1998). Finding that primary drug resistance to certain classes of antiretroviral therapy is increasing overtime, and is associated with delayed virological responses to therapy (JAMA 2002). Finding that drug resistant viremia is associated with preserved CD4+ T cell count responses to therapy, suggesting a trade-off for the virus between resistance and virulence (AIDS 1999). Persistent partial CD4+ T cell count responses proved to require continued exposure to therapy that retains partial antiviral activity and maintains selection for viruses with diminished replication capacity (NEJM 2001).

5. Pre-exposure Prophylaxis is safe, effective, and feasible: Dr. Grant's iPrEx trial found that daily oral emtricitabine/tenofovir disoproxil fumarate decreases HIV acquisition among men who have sex with men and transgender women (NEJM 2010). He also conducted the first open label demonstration project of preexposure prophylaxis, showing that adherence is higher when information about safety and efficacy is provided (Lancet ID 2014). He published the first and still largest series of PrEP use among transgender women (Deutsch 2015). He and his colleagues Identified a correlate of protection and a candidate surrogate marker for efficacy of pre-exposure prophylaxis (Anderson 2012).
 
 
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  1. Mannheimer S, Hirsch-Moverman Y, Franks J, Loquere A, Hughes JP, Li M, Amico KR, Grant RM. Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067. . 2019 04 15; 80(5):551-558.
  2. Spinelli MA, Glidden DV, Rodrigues WC, Wang G, Vincent M, Okochi H, Kuncze K, Mehrotra M, Defechereux P, Buchbinder SP, Grant RM, Gandhi M. Low tenofovir level in urine by a novel immunoassay is associated with seroconversion in a preexposure prophylaxis demonstration project. AIDS. 2019 04 01; 33(5):867-872.
  3. Truong HM, Pipkin S, Grant RM, Liegler T, O'Keefe KJ, Scheer S. Increased uptake of early initiation of antiretroviral therapy and baseline drug resistance testing in San Francisco between 2001 and 2015. PLoS One. 2019; 14(3):e0213167.
  4. Cohen SE, Sachdev D, Lee SA, Scheer S, Bacon O, Chen MJ, Okochi H, Anderson PL, Kearney MF, Coffey S, Scott H, Grant RM, Havlir D, Gandhi M. Acquisition of tenofovir-susceptible, emtricitabine-resistant HIV despite high adherence to daily pre-exposure prophylaxis: a case report. Lancet HIV. 2018 Nov 29.
  5. Murray MI, Markowitz M, Frank I, Grant RM, Mayer KH, Hudson KJ, Stancil BS, Ford SL, Patel P, Rinehart AR, Spreen WR, Margolis DA. Satisfaction and acceptability of cabotegravir long-acting injectable suspension for prevention of HIV: Patient perspectives from the ECLAIR trial. HIV Clin Trials. 2018 08; 19(4):129-138.
  6. Mehrotra ML, Rivet Amico K, McMahan V, Glidden DV, Defechereux P, Guanira JV, Grant RM. The Role of Social Relationships in PrEP Uptake and Use Among Transgender Women and Men Who Have Sex with Men. AIDS Behav. 2018 Nov; 22(11):3673-3680.
  7. Stekler JD, Violette LR, Niemann L, McMahan VM, Katz DA, Baeten JM, Grant RM, Delaney KP. Repeated False-Positive HIV Test Results in a Patient Taking HIV Pre-Exposure Prophylaxis. Open Forum Infect Dis. 2018 Sep; 5(9):ofy197.
  8. Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health. 2018; 6:250.
  9. Colby DJ, Kroon E, Sacdalan C, Gandhi M, Grant RM, Phanuphak P, Ananworanich J, Robb ML, Phanuphak N. Acquisition of Multidrug-Resistant Human Immunodeficiency Virus Type 1 Infection in a Patient Taking Preexposure Prophylaxis. Clin Infect Dis. 2018 08 31; 67(6):962-964.
  10. Glidden DV, Mulligan K, McMahan V, Anderson PL, Guanira J, Chariyalertsak S, Buchbinder SP, Bekker LG, Schechter M, Grinsztejn B, Grant RM. Metabolic Effects of Preexposure Prophylaxis With Coformulated Tenofovir Disoproxil Fumarate and Emtricitabine. Clin Infect Dis. 2018 07 18; 67(3):411-419.
  11. Truong HM, Fatch R, Grant RM, Mathur M, Kumta S, Jerajani H, Kellogg TA, Lindan CP. Characterization of HIV Recent Infection Among High-Risk Men at Public STI Clinics in Mumbai. AIDS Behav. 2018 Jul; 22(Suppl 1):70-75.
  12. Jotwani V, Scherzer R, Glidden DV, Mehrotra M, Defechereux P, Liu A, Gandhi M, Bennett M, Coca SG, Parikh CR, Grant RM, Shlipak MG. Pre-exposure Prophylaxis With Tenofovir Disoproxil Fumarate/Emtricitabine and Kidney Tubular Dysfunction in HIV-Uninfected Individuals. . 2018 06 01; 78(2):169-174.
  13. Ryan KE, Mak A, Stoove M, Price B, Fairley CK, Ruth S, Lal L, Asselin J, El-Hayek C, Nguyen L, Batrouney C, Wilson D, Lockwood J, Murphy D, Cornelisse VJ, Roth N, Willcox J, Chang CC, Armishaw J, Tee BK, Penn M, Forgan-Smith G, Williams C, Montgomery J, Byron K, Coelho A, Allen B, Wiggins J, Kelsall J, Vujovic O, West M, Pierce AB, Gallant D, Bell C, de Wit JBF, Hoy JF, Wesselingh SL, Grant RM, Wright EJ. Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study. Front Public Health. 2018; 6:151.
  14. Grant RM, Mannheimer S, Hughes JP, Hirsch-Moverman Y, Loquere A, Chitwarakorn A, Curlin ME, Li M, Amico KR, Hendrix CW, Anderson PL, Dye BJ, Marzinke MA, Piwowar-Manning E, McKinstry L, Elharrar V, Stirratt M, Rooney JF, Eshleman SH, McNicholl JM, van Griensven F, Holtz TH. Daily and Nondaily Oral Preexposure Prophylaxis in Men and Transgender Women Who Have Sex With Men: The Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study. Clin Infect Dis. 2018 05 17; 66(11):1712-1721.
  15. Davis AK, Barsuglia JP, Lancelotta R, Grant RM, Renn E. The epidemiology of 5-methoxy- N, N-dimethyltryptamine (5-MeO-DMT) use: Benefits, consequences, patterns of use, subjective effects, and reasons for consumption. J Psychopharmacol. 2018 07; 32(7):779-792.
  16. Figueroa DB, Tillotson J, Li M, Piwowar-Manning E, Hendrix CW, Holtz TH, Bokoch K, Bekker LG, van Griensven F, Mannheimer S, Hughes JP, Grant RM, Bumpus NN. Discovery of genetic variants of the kinases that activate tenofovir among individuals in the United States, Thailand, and South Africa: HPTN067. PLoS One. 2018; 13(4):e0195764.
  17. Franks J, Hirsch-Moverman Y, Loquere AS, Amico KR, Grant RM, Dye BJ, Rivera Y, Gamboa R, Mannheimer SB. Sex, PrEP, and Stigma: Experiences with HIV Pre-exposure Prophylaxis Among New York City MSM Participating in the HPTN 067/ADAPT Study. AIDS Behav. 2018 04; 22(4):1139-1149.
  18. Mitchell KM, Dimitrov D, Hughes JP, Xia F, Donnell D, Amico KR, Bokoch K, Chitwarakorn A, Bekker LG, Holtz TH, Mannheimer S, Grant RM, Boily MC. In what circumstances could nondaily preexposure prophylaxis for HIV substantially reduce program costs? AIDS. 2018 03 27; 32(6):809-818.
  19. Fuchs JD, Stojanovski K, Vittinghoff E, McMahan VM, Hosek SG, Amico KR, Kouyate A, Gilmore HJ, Buchbinder SP, Lester RT, Grant RM, Liu AY. A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis. AIDS Patient Care STDS. 2018 03; 32(3):104-111.
  20. Hojilla JC, Vlahov D, Glidden DV, Amico KR, Mehrotra M, Hance R, Grant RM, Carrico AW. Skating on thin ice: stimulant use and sub-optimal adherence to HIV pre-exposure prophylaxis. J Int AIDS Soc. 2018 03; 21(3):e25103.
  21. Eshleman SH, Piwowar-Manning E, Sivay MV, Debevec B, Veater S, McKinstry L, Bekker LG, Mannheimer S, Grant RM, Chesney MA, Coates TJ, Koblin BA, Fogel JM. Performance of the BioPlex 2200 HIV Ag-Ab assay for identifying acute HIV infection. J Clin Virol. 2018 Feb - Mar; 99-100:67-70.
  22. Baxi SM, Vittinghoff E, Bacchetti P, Huang Y, Chillag K, Wiegand R, Anderson PL, Grant R, Greenblatt RM, Buchbinder S, Gandhi M, Liu AY. Comparing pharmacologic measures of tenofovir exposure in a U.S. pre-exposure prophylaxis randomized trial. PLoS One. 2018; 13(1):e0190118.
  23. Markowitz M, Grossman H, Anderson PL, Grant R, Gandhi M, Horng H, Mohri H. Newly Acquired Infection With Multidrug-Resistant HIV-1 in a Patient Adherent to Preexposure Prophylaxis. J Acquir Immune Defic Syndr. 2017 12 01; 76(4):e104-e106.
  24. Hojilla JC, Mehrotra M, Truong HM, Glidden DV, Amico KR, McMahan V, Vlahov D, Chariyalertsak S, Guanira JV, Grant RM, For The iPrEx Study Team . HIV sero disclosure among men who have sex with men and transgender women on HIV pre-exposure prophylaxis. AIDS Care. 2018 04; 30(4):466-472.
  25. Bekker LG, Roux S, Sebastien E, Yola N, Amico KR, Hughes JP, Marzinke MA, Hendrix CW, Anderson PL, Elharrar V, Stirratt M, Rooney JF, Piwowar-Manning E, Eshleman SH, McKinstry L, Li M, Dye BJ, Grant RM, HPTN 067 (ADAPT) study team . Daily and non-daily pre-exposure prophylaxis in African women (HPTN 067/ADAPT Cape Town Trial): a randomised, open-label, phase 2 trial. Lancet HIV. 2018 02; 5(2):e68-e78.