By Steve Lewis
BETHESDA, MD – Ann Marie Nelson, MD, FASCP, a senior member of the Joint Pathology Center (JPC) in Bethesda, MD – the federal government’s premier pathology reference center supporting the Military Health System, DoD and other federal agencies – recently was presented with the International Academy of Pathology’s Gold Medal Award.
Nelson, an anatomic and clinical pathologist, is recognized among the world’s leading experts in the field of infectious diseases, particularly HIV and AIDS. In a news release about the award, Michael L. Wilson, MD, FASCP, editor-in-chief of ASCP’s American Journal of Clinical Pathology, and vice-chair in the Department of Pathology at the University Of Colorado School Of Medicine, Denver, said, “Dr. Nelson has had the greatest presence in global pathology of any U.S. pathologist during the past 25 years.”
Nelson’s interest in the field was piqued in 1979 while she was doing her “fifth pathway” work following medical school in Guadalajara, Mexico. While taking a course on tropical medicine, she heard a lecture by Daniel H. Connor, MD, who had done groundbreaking work in tropical pathology in Uganda from 1960 to 1963.
“It was then that I decided that I wanted to work on infectious diseases when I ‘grew up,’” she shares.
She then did her residency at the West Los Angeles VA from 1980 to 1984, choosing the VA facility because it had a strong infectious diseases department. Required to do four months of rounds, she had the opportunity to get in touch with the patient population. Because of her VA experience and because she had a brother who was a Vietnam veteran 100% disabled due to PTSD, “There was extra meaning serving these patients.”
During her residency, gay-related immune deficiency (GRID) and later acquired immune deficiency syndrome (AIDS) first came up. “Since we were a teaching affiliate of UCLA and saw a lot of the same people, we had a few vets who had HIV and I’d go up and spend time with them, trying to learn why they had these funny white [blood cell] counts,” Nelson recalls. She learned that the VA patients had been IV drug users and “less open” homosexuals.
Work Began in Africa
Following her residency, Nelson obtained a position at the Armed Forces Institute for Pathology (AFIP) in Maryland and worked for Connor. Interestingly, she notes, her AFIP colleagues now “form the core of the JPC.”
She traveled to northern Zaire in early 1986, where AFIP had a longstanding relationship with missionaries. HIV was not known in Africa at the time, but tuberculosis was an area of keen focus.
After several months in Zaire, Nelson returned to the United States, only to head back to Zaire that September to set up a pathology component at the University of Kinshasa for Project SIDA, the first international HIV/AIDS research project in Africa. She conducted autopsies on patients who appeared to have died from complications of AIDS.
She then returned to the U.S. in 1991 and did AIDS pathology work as a contractor with the American Registry of Pathology, New York.
In 1994, she was hired by VA, which provided the majority of HIV cases she studied. She became chief of the AIDS division, starting a registry which included a database of all the cases that came into the department.
“It did not have the patient’s name, but it had their age, CD4 count and viral load, and you could see sequences of cases,” she explains. “It allowed you to start to see Hodgkin’s disease, lung cancer and large numbers of co-morbidities, as well as differences between males and females.”
New Decade, New Focus
As Nelson describes it, the main focus of AIDS studies in the 1980s was opportunistic infections. “In the 1990s, we did a lot of work on the toxicity of antiretroviral therapy,” she recounts.
“In the late 1990s when different therapies were developed, people with AIDS began to live longer,” she notes, but adds that with antiretroviral therapy came adverse reactions, such as liver disease. “For example, you could go blind even though you got better.”
As a result of those studies, “We decided we really had to start treating people with higher CD4 counts — when they are as well as possible,” Nelson points out. “Some patients couldn’t stay on the drugs, which was a big problem in the VA population.”
Her challenge, then, was to document the pathology related to the drugs themselves, such as liver damage, skin rashes, and other adverse reactions. “Having the registry helped catalogue those complications,” she notes.
The last 10 years, says Nelson, have been about long-term disease associated with HIV, explaining, “What we see are tumors, cervical cancer not getting better, lymphomas and cardiovascular disease.”
Nelson says she doesn’t see that many HIV cases now and that at JPC, which opened in 2001, the focus is more on general work in infectious diseases. Still, she recently returned to Kenya and Uganda to study individuals for whom antiretroviral therapy was fatal.
Nelson has no plans to stop working on her life’s passion. “If I retired, it would be because somehow I won the lottery,” she jokes.
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