UCSF patient care experts specialize in a wide range of immunological and infectious diseases.
As a leading health sciences institution with a top academic medical center, UCSF conducts numerous clinical trials and offers opportunities to patients to enroll in trials of the most promising new treatments. Patients benefit directly from collaborations of clinical and research teams.
National rankings place UCSF clinical programs among the top 10 in the country. In the 2010-2011 US News & World Report survey on the nation’s best hospitals, UCSF patient care in diabetes and endocrine disorders ranks No. 4, and patient care in rheumatology ranks No. 10.
Many Types of Immune Challenges
UCSF provides care for patients with many types of immune challenges, whether caused by disease or rejection of donated organs.
- Diabetes: The UCSF Diabetes Center, which marked its 10th anniversary in 2010, unites the research, clinical care and education aspects of diabetes in a comprehensive program to improve the quality of life of those living with diabetes.
The center treats both adults and children, and specializes in clinical trials to test new therapies for all forms of the disease, including type 1 diabetes, which occurs when the body’s immune system destroys the pancreatic beta cells that make insulin.
- Rheumatoid arthritis: Consistent care and monitoring are essential to gain a firm understanding of ways to advance treatments for this disorder, and UCSF clinical specialists are tracking the progress of rheumatoid arthritis disease and treatment in the largest cohort of patients ever studied. They are studying patients’ family histories, genetics, disease markers in their blood and different ways the disease is expressed. Immune disorders often manifest in many different ways, from skin disease and joint stiffening to heart and kidney inflammation. Patients in the cohort receive care from some of the world’s top clinicians. Andrew Gross, MD, is director of clinical programs in rheumatology and chief of the UCSF Rheumatology Clinic.
- Lupus: The lupus clinic at UCSF is assessing new drugs for this autoimmune disease, which can affect various parts of the body, especially the skin, joints, blood and kidneys. One drug, derived from a protein in the body rather than a synthesized chemical, is already in use to treat arthritis. Clinical researchers have found that it also has potential in providing benefit to lupus patients. Rheumatology specialists David Wofsy, MD, and Maria Dall’Era, MD, are directing a clinical trial to investigate its effectiveness.
- Pediatric immunology: Physicians in the Pediatric Immunology clinic treat children with known or suspected inherited immune disorders, such as severe combined immunodeficiency (SCID), and disorders of immune regulation. These diseases must be identified and treated early to prevent infectious complications, says Jennifer Puck, MD, director of the UCSF Jeffrey Modell Foundation Diagnostic Center for Primary Immunodeficiencies. Findings from the clinic have led to discoveries of a human disease gene that leads to SCID.
- Asthma: Specialized care for asthma patients includes the UCSF Airway Clinical Research Center, which is part of a national network of clinical sites that provides treatment of, and investigates new drugs and other therapies for, airway conditions. In addition, the UCSF Asthma Clinic combines consultation and education programs to encourage patients to better manage their own care. Much of the program draws on research and treatment by Susan Janson, RN, DNSc, a professor in the School of Nursing. Her studies found it was feasible in a brief clinic appointment for patient care staff to effectively educate patients in self-management of their disease, resulting in a decrease in symptoms, an improvement in adherence to medication and a reduction in biological markers of airway inflammation.
- Transplant patients: UCSF has one of the busiest transplant centers in the country, and patients benefit from advances in surgical procedures and organ rejection therapies either initiated or first carried out at UCSF. As part of UCSF’s team approach to comprehensive care, transplant immunologists carefully monitor all transplant patients for their response to immunosuppressive medications to combat organ rejection. Ongoing clinical trials provide patients with the option of enrolling in trials to test new types of anti-rejection drugs. UCSF is the world leader in performing liver and kidney transplant procedures in HIV patients. Successful transplants are particularly difficult for these patients because of their compromised immune systems.
Clinical trials for these and other immune disorders are supported by the Immune Tolerance Network (ITN), a consortium of the world's leading scientific researchers and clinical specialists who focus on testing new therapies to promote immune tolerance in transplantation, autoimmune diseases (such as type 1 diabetes, multiple sclerosis and lupus), asthma and allergic diseases.
Treating the Full Range of Infectious Diseases
UCSF specialists treat the full range of infectious diseases, including many complicated cases in which previous treatment has been unsuccessful, says Joanne Engel, MD, PhD, chief of the Division of Infectious Diseases and UCSF professor of medicine and of microbiology and immunology.
Joanne Engel, MD, PhD, Chief, Division of Infectious Diseases
UCSF is widely recognized for rigorous efforts to diagnose and treat advanced infections, whether from viral, bacterial, fungal, parasitic or other infectious agents, and these insights have led to changes nationwide in treatment.
Clinical care is provided by infectious diseases (ID) experts who specialize in treating both inpatients and outpatients.
- General infections and infectious disease problems specific to immunocompromised patients: ID teams treat hospitalized patients with any infectious disease problem, and there is a special team for treating infections in immunocompromised patients. The ID division maintains clinics for treating these health issues on an outpatient basis.
Many of the patients treated at UCSF are particularly vulnerable to infections because their immune systems are compromised due to their disease, such as lupus, or as a result of their therapies, such as transplant recipients taking antirejection medications and those with cancer undergoing chemotherapy.
- UCSF Travel Medicine and Immunization Clinic: This outpatient service for the public provides pre-travel care, including medical evaluation, education about prevention of illness, prescriptions against diarrheal and vector-borne diseases, and immunizations. Immunizations include those for yellow fever, Japanese encephalitis, typhoid, hepatitis A, rabies, meningococcal meningitis, tetanus, diphtheria, pertussis and others. “The majority of travel-related illnesses can be prevented with proper education, prophylactic medications and immunizations,” says Brian Schwartz, MD, clinic medical director. The UCSF program for HIV-infected patients is among the most comprehensive in the world, providing highly regarded clinical treatment and pioneering programs to integrate traditional care with expertise in drug selection, nutrition, counseling and other critical concerns often not addressed in HIV treatment.
- 360: The Positive Care Center: The center, located at UCSF Medical Center at Parnassus Heights, provides a range of services, including a program for HIV patients experiencing accelerated aging, a major concern because the majority of US HIV patients will soon be over 50 years old. One new initiative will provide the first urban-based HIV telemedicine program, connecting 360 to community clinics, and will thereby provide patients with one-on-one diagnostic, nutritional and drug expertise that local clinics may not be able to offer in full. “We provide treatment that brings together clinicians, nutritionists, pharmacists, social workers and other experts to augment traditional HIV care and tailor it to individual patients,” says Malcolm John, MD, MPH, director of 360. “While we provide care, we develop and test new models of care for treating well beyond San Francisco.”
- The Women’s HIV Program: This program has served HIV-infected women in San Francisco since the early 1990s. It provides a one-stop clinic setting where women can receive medical treatment, psychiatric and social work services, pharmaceutical services, and case management at one site. One of the biggest success stories of the clinic is the integration of specialty HIV obstetric management to provide comprehensive care to HIV-infected pregnant women, with the aim of delivering healthy, noninfected babies.
- UCSF Positive Health Program at San Francisco General Hospital (SFGH): Founded in 1983 as a collaboration between UCSF and SFGH, this is the oldest HIV clinic in the country and the second-largest, serving 3,000 outpatients. The program now encompasses a network of specialty clinics, a system of research and clinical trials, an education unit, and a community forum for doctors and researchers. In addition to HIV/AIDS care, the program provides oncology and hematology services. Diane Havlir, MD, UCSF professor of medicine, is chief of the HIV/AIDS Division at SFGH.
In addition to its clinical expertise, UCSF is home to one of the country’s most highly regarded antimicrobial drug management programs, operated through the School of Pharmacy. The program advises clinicians on treatments tailored to specific infections and promotes strategies to limit the use of broad-spectrum drugs in order to combat bacterial resistance.