Alumna Profile – Joan Cox Gill, MD ’76
In the early 1980s, researchers at The Medical College of Wisconsin were at the center of solving the mysteries of the recently identified AIDS (Acquired Immune Deficiency Syndrome) that would soon escalate into an epidemic. Among them was Joan Cox Gill, MD ’76, currently Director of the Comprehensive Center for Bleeding Disorders at the BloodCenter of Wisconsin and Professor of Pediatrics and Medicine at the Medical College.
Following the announcement by the Centers for Disease Control (CDC) that AIDS was suspected to be blood borne, Dr. Gill and Robert Montgomery, MD, of the Great Lakes Hemophilia Treatment Center and the BloodCenter joined Jay Mentove, MD, an investigator at the BloodCenter, to initiate a study to prove the blood borne theory. Last year marked the 25th anniversary of their results being published in the New England Journal of Medicine.
“At the time, we didn’t even know that HIV [the virus that leads to AIDS] was causing the immunologic abnormalities in patients with hemophilia or in other risk groups that were being affected by this devastating immunologic deficiency,” said Dr. Gill, who also directs the Hemophilia Program at Children’s Hospital of Wisconsin.
As a group, patients with hemophilia were prime candidates for the clinical investigation because many had the immunologic abnormalities associated with AIDS, and they were exposed to a significantly large number of blood donors. One lot of blood concentrate infused in a hemophilic patient to treat a bleeding episode could contain blood from as many as 20,000 to 30,000 blood donations.
“Our hypothesis was that if the AIDS agent was transmitted in blood, we would find immunologic abnormalities similar to those found in AIDS patients in higher frequency in those exposed to more blood donors,” Dr. Gill said. “In fact, that is what we found. We went on to show that the immunologic abnormalities persisted in those affected with the AIDS virus.”
Once HIV (then called HTLV-III) was identified as the AIDS virus, Dr. Gill and the other researchers demonstrated that those with immunologic abnormalities had developed antibodies to the virus.
Results of the research caused blood collection centers, such as the BloodCenter of Wisconsin and American Red Cross, to implement additional testing procedures before declaring a unit of blood safe for medical use. However, early testing was limited. For the first three weeks after a person contracted a virus, test results would appear negative. If someone made a donation during that time, the contaminated blood had the potential to make it into the blood supply. In the years since the discovery of HIV, the three-week window has been eliminated through NAT testing, which tests for the genome of the viruses.
“NAT testing is much more sensitive and can pick up infected donors before they actually have an immunologic response,” Dr. Gill said. “The risk of HIV in a unit of blood is now about one in a million.”
Another result of the blood borne AIDS virus study was the improvement of treatment products for hemophilia patients. Manufacturers began instituting virus inactivation steps, effectively eliminating HIV from their products by about 1983-84.
Dr. Gill is currently concentrating her research on other complications of hemophilia. She is working on a study of hemophilia patients who develop antibodies that reject their clotting treatments. Defining why some patients develop antibodies and others do not could lead to prevention and treatment of the antibodies.
She is also co-investigator with Dr. Montgomery, now Professor of Pediatric Hematology at the Medical College, on an NIH-funded investigation of the clinical and molecular biology of von Willebrand disease, a bleeding disorder that causes easy bruising, nosebleeds and menorrhagia. Other research includes a study with Ron Hines, PhD, Professor of Pharmacology and Toxicology at the Medical College, on genetic factors involved in how individuals metabolize anticoagulants used to prevent blood clots. She is also involved with the CDC’s new program to learn more about women with bleeding disorders.