Myron Cohen, MD

About

In addition to serving as Institute for Global Health and Infectious Diseases (IGHID) director, Dr. Cohen is the Yeargan-Bate Eminent Professor of Medicine, Microbiology and Immunology and Epidemiology at UNC.

In 2007 he was appointed Associate Vice Chancellor for Health Affairs. Dr. Cohen has served as the Director of the UNC Division of Infectious Diseases since 1988 and is associate director of the UNC Center for AIDS Research. Dr. Cohen’s research focuses on the transmission and prevention of HIV, with emphasis on the role played by STD co-infections.

Dr. Cohen is the architect and principal investigator of the multinational HIV Prevention Trials Network (HPTN) 052 study, which demonstrated that antiretroviral treatment prevents the sexual transmission of HIV-1. This work was recognized by Science Magazine as the “Breakthrough of the Year” in 2011. He is a member of the Institute of Medicine, the American Society of Clinical Investigation and the American Association of Physicians.

Myron Cohen in the Gillings News

Honors and Awards

North Carolina Award for Science
2013, State of North Carolina

Joseph E. Smadel Lectureship Award
2013, Infectious Diseases Society of America

O. Max Gardner Award for Medicine, Microbiology, & Public Health
2008, UNC-Chapel Hill

Distinguished Career Award Lifetime Achievement in STD/HIV Research
2005, American Sexually Transmitted Diseases Association

Research Activities

Dr. Cohen works in clinical research, clinical trials, translational research and basic science research. He is an infectious disease specialist widely known for his work on transmission and prevention of transmission of HIV. His work has focused on HIV prevention and has involved clinical research, global research, and use of the tools of epidemiology, virology and pharmacology. Dr. Cohen helped to develop laboratory methods to measure HIV in genital secretions, as well as methods to determine the best antiviral agents to reduce replication of HIV in these compartments.

• Amplified transmission of HIV-1: He worked on sexually transmitted diseases, especially N. gonorrhea and mucosal secretions. With the inception of the AIDS pandemic the focus switched to the biology of the sexual transmission of HIV and the circumstances in which HIV transmission might be amplified. They conducted studies of HIV in seminal plasma, originally measuring replication competent HIV-1 by culture, and later based on HIV-1 RNA copy number. Reasoning that classical sexually transmitted diseases were driving HIV transmission. Working in Lilongwe Malawi, they demonstrated that men with gonococcal urethritis had 8 fold greater concentration of HIV-1 RNA in semen (but not blood) and that treatment of gonorrhea reversed this effect over a few days. They also studied HIV sequences recovered from semen and demonstrated compartmentalization and clonal amplification.
• The role of acute infection in transmission of HIV-1: The first days of HIV infection-the window of acute and early infection- greatly define the natural history of the infection. In addition, HIV transmission is amplified during this time. To find people with acute infection they developed screening techniques. For example, in North Carolina they worked with the state government to develop a program where all HIV antibody negative samples are examined for RNA through a mass pooling strategy. In Malawi they developed an algorithm to identify HIV antibody negative subjects with acute HIV presenting to an STD clinic. The recruitment of a large number of subjects with acute HIV infection allowed determination of some of the details of the HIV transmission event and the immune response. Using samples from blood it was demonstrated that most people acquire 1 and no more than three HIV variants. In addition, early treatment of subjects with acute HIV infection reduces the HIV latent reservoir.
• Pharmacology of ART in the genital tract: Their team has worked to characterize the differences between ART in the blood, and the male and female genital tract. This work led to identification of drugs best suited to pursue the "treatment as prevention strategy" and has informed development of pre-exposure prophylaxis. The nucleoside reverse transcriptase inhibitors are phosphorylated more slowly in seminal mononuclear cells than blood mononuclear cells, and may not reach the same intracellular concentration of the phosphorylated product. In women metabolism of tenofovir and emtricitabine differed greatly between the rectum and the cervix and vagina; more efficient and reliable phosphorylation of tenfovir in the rectum may explain the superior performance of the tenofovir-emtricitabine combination in prevention of HIV acquisition in MSM compare to heterosexual women.
• Treatment for prevention of transmission of HIV-1: They reasoned that ART which concentrated in the genital tract could durably reduce sexual transmission of HIV-1. Through the HIV Prevention Trials Network (HPTN) they launched the HPTN 052 trial in which HIV infected subjects in a discordant relationship were randomized to compare early ART (median CD4 count 446) and delayed ART (median CD4 226). This clinical trial represented the culmination of all their work in ART metabolism presented above. The study results demonstrated that ART (combined with condoms and couples counseling reduced HIV transmission by 96.4%; more recently they have reported that the results are durable if suppression of HIV is maintained. Subjects treated early had reduced incidence of tuberculosis as well. Introduction of early ART is very cost effective.

Key Publications

Adherence to early antiretroviral therapy: Results from HPTN 052, a phase III, multinational randomized trial of ART to prevent HIV-1 sexual transmission in serodiscordant couples. David Celentano, Ying Chen, Myron Cohen, Theresa Gamble, Beatriz Grinsztejn, Irving Hoffman, Mina Hosseinipour, Nagalingeswaran Kumarasamy, Kenneth Mayer, Marybeth McCauley, San-San Ou, Steven Safren (2015). Journal of Acquired Immune Deficiency Syndromes, 69(2), 234-240.

Bottlenecks in HIV-1 transmission: Insights from the study of founder viruses. Myron Cohen, Sarah Joseph, Angela Kashuba, Ronald Swanstrom (2015). Nature Reviews Microbiology, 13(7), 414-425.

How can we better identify early HIV infections? Michael Busch, Myron Cohen, Christopher Pilcher, Nora Rosenberg (2015). Current Opinion in HIV and AIDS, 10(1), 61-68.

Immunologic, virologic, and pharmacologic characterization of the female upper genital tract in HIV-infected women. Myron Cohen, Mackenzie Cottrell, Cindi Emerson, Angela Kashuba, Julie Nelson, Kristina Paris, Kristine Patterson, Lisa Rahangdale, Trenton Stevens, Craig Sykes, Steven Young (2015). Journal of Acquired Immune Deficiency Syndromes, 68(4), 420-424.

Models for predicting effective HIV chemoprevention in women. Myron Cohen, Cindi Emerson, Yuri Fedoriw, Elizabeth Geller, Angela Kashuba, Julie Nelson, Melanie Nicol, Kristine Patterson, Heather Prince, Craig Sykes (2015). Journal of Acquired Immune Deficiency Syndromes, 68(4), 369-376.

Ongoing HIV transmission and the HIV care continuum in North Carolina. Jeffrey Anderson, Myron Cohen, Anna Cope, Joseph Eron, Evelyn Foust, Cynthia Gay, Laura Kincer, JoAnn Kuruc, Peter Leone, William Miller, Victoria Mobley, Li-Hua Ping, Kimberly Powers, Ronald Swanstrom (2015). PLoS ONE, 10(6).

Education