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Deborah Persaud

Born: Aug. 23, 1960, Guyana, South America.

Education: B.A., York College (CUNY); M.D., NYU Medical School; pediatric residency (chief resident), Columbia-Presbyterian.

Career Highlights: Aaron Diamond Fellow, NYU; Doris Duke Clinical Research Fellow, JHUSOM.

Current Position: Associate (recent) professor, pediatric infectious diseases, JHUSOM; Elizabeth Glaser Scientist.

Family: William Moss, M.D., M.P.H, pediatric infectious diseases specialist, Bloomberg SPH; three children: Taylor, 10; Ian, 8; Soraya, 6.

Hobbies: Chauffeuring.

What people should know about her: “I am the American dream.”

Deborah Persaud: Clinician First, Scientist Second

Deborah Persaud probes drug resistance in children with HIV.

On an afternoon last December, Deborah Persaud was summoned to a meeting by her division head. What to do? It was her day to pick up the kids at day care. She called her husband; he agreed to switch with her.

At the appointed hour, believing she was headed for yet another discussion on space or money, dressed in a tired lab coat, Persaud headed for the conference room. A festive celebration was under way. Everyone she knew was there: her colleagues, her mentors, her department and division chairmen—even her husband and three young children.

At first she thought she’d been promoted to associate professor. (Her application had been in for more than a year.) But when she spotted a friend from the Elizabeth Glaser Pediatric AIDS Foundation, she knew instantly what had happened: “I knew I had received the Elizabeth Glaser Scientist Award.”

Every year, this foundation, a major player in the fight against pediatric AIDS, presents its most prestigious award to several of the most promising HIV/AIDS researchers at a critical stage in their careers. This year, Persaud was the only recipient. She will use the money—$700,000 for five years—to better understand drug-resistant HIV in children both in the United States and abroad.

Persaud (pronounced “per-SOD”) came to Johns Hopkins in 1997 on the heels of a discovery, made here, which demonstrated that HIV infection cannot be entirely eradicated by highly active antiretroviral therapy, or HAART, because the infection persists in a silent, or latent, reservoir in resting memory cells. Furthermore, this latent reservoir is a permanent “archive” for viruses that are drug resistant.

For pediatricians like Persaud, who aim to ensure that HIV/AIDS studies in children stay abreast of those in adults, the question then became: Did this same latent reservoir exist in children? No one had yet done similar studies in children, in part because they required quite a bit of blood—about half a pint or more from each patient.

Persaud is a clinician-scientist who eschews the term “bench-to-bedside” in favor of “bedside-to-bench.” For her, everything begins at the bedside. For these planned studies, she could work closely with the patients (the first wave of children treated with HAART at Johns Hopkins were then coming through the Intensive Primary Care Clinic) and with her fellow clinicians.

Using special, ultrasensitive molecular tests, Persaud found the same latent reservoirs in children. “They’re stored, they’re archived, and they’re there.” She then examined the genetics and evolution of the virus and found that while resistant viruses are continuously being produced in children on HAART, they are not evolving, and their presence does not mean that the drug regimen is failing.

Persaud was a medical student at NYU in 1985 when the first cases of HIV were being identified in young, gay men. During her residency at Columbia Presbyterian, she started seeing infants presenting with the same type of pneumonia. “It was actually devastating because an infected infant meant an infected mother, father and, possibly, other siblings. Eighty percent of these infants died in the first year of life, and we could do nothing. We had no therapies.”

Today, 20 years later, HIV infection has been transformed into a preventable, treatable disease in children, and Persaud now is studying the virus at the single-cell level. “I’ve been fortunate to have witnessed the beginning of the epidemic and the multiple phases of HIV infection. It’s been transformed into a chronic infection. What I hope for the future is to be able to see a similar transformation in resource-poor settings.”

With the Glaser grant, Persaud will study therapies in the United States as well as in Ethiopia. In Africa, since 2000, an inexpensive, single dose of the drug nevirapine has been administered to an estimated half-million mothers in labor and, then, their newborns. It has reduced infection rates by at least one-half among babies. But unlike the three-or-more-drug therapy (HAART) used in the United States, a single dose of this single drug can spur resistance and compromise future therapy for infants in settings where HAART is limited to nevirapine-containing regimens.

Persaud will use her ultrasensitive methods to figure out how long the resistant virus persists at low levels in children in Ethiopia who received nevirapine for prevention of infection at birth or by breast milk. She will study the impact of HAART (which includes nevirapine) on those who developed the infection despite having taken nevirapine. Third, she will try to pinpoint the best time to get U.S.-born, infected children started on HAART. “Hopefully, this work will be applied to children in resource-poor settings,” she says. “Studying therapies in both parts of the world that can benefit all children has been my mission in all of this.”

When she won the Glaser award, Persaud was hailed as “one of the best and brightest AIDS researchers in the field today.” To get to this point, she has overcome incredible odds. Until she was 16, she lived in Guyana, a South American country on the Atlantic coast. Her parents had divorced, and when she was 10, her mother went to America to find work. Six years later, Persaud and her three siblings joined her in Brooklyn, N.Y.—in the battered neighborhood of Bushwick. After Persaud completed high school and college, just one medical school, NYU, accepted her. That was all she needed to get on a career trajectory that would consistently put her precisely in the right place at the right time.

It was not until the prestigious Glaser award was formally announced on Feb. 23 at a research conference in Boston that its full import sank in. Looking around at the roomful of notable scientists, Persaud felt as though she really belonged. “That is when I realized that I actually had impacted pediatric HIV in this country.”

—Anne Bennett Swingle



Johns Hopkins Medicine

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