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On her first night as an intern at Wellesley Hospital in 1983, Dr. Sharon Walmsley was assigned to see a patient suffering from an unknown lung affliction.
Dr. Charlie Chan, then a respiratory fellow at Wellesley and now UHN's EVP & Chief Medical Officer, came to the emergency room to consult on the case.
"I bet you this is a case of AIDS," Dr. Chan said.
"Never heard of it," Dr. Walmsley thought. Few doctors knew what AIDS was at the time.
She went home in tears that night, overwhelmed that she didn't know anything about her patient's suspected illness on her first night as a doctor. It was ultimately determined that this case was AIDS – one of the first recorded cases in Toronto.
It was the beginning of an epidemic in the city.
Soon afterwards, her subsequent mentor, Dr. Hillar Vellend, Chief of Infectious Diseases at the Toronto General Hospital (TGH), came to consult on the case.
"He said to me, 'Listen, this is something interesting. Why don't you run with this,' " Dr. Walmsley recounts in her office in TGH 34 years later, sporting bright red ribbon pins on her lab coat symbolizing HIV/AIDS awareness.
"I soon grew to be a local expert on HIV and just never looked back. That night shaped the rest of my career."
Earlier this summer, Dr. Walmsley was named a Member of the Order of Canada, the country's highest civilian honour. Participating in more than 200 clinical trials in her career, she is being recognized for her research on clinical management of HIV/AIDS, with investigation of improved treatment options, and her focus on addressing the need to assess gender differences in outcomes.
She currently is a Senior Scientist at the Toronto General Hospital Research Institute, Director of the Clinical Research Program, Immunodeficiency Clinic, TGH, and Professor of Medicine in the Department of Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, and co-director of the Canadian HIV Clinical Trials Network.
"She's a pioneer in HIV research and one of the leaders that saved many lives by helping to change HIV from a fatal to chronic disease," says Dr. Chan, who has known Dr. Walmsley for her entire career. "She brings a sense of humour to her day-to-day work and with passion for driving HIV research and devotion to patients."
Dr. Walmsley's 34-year career as a leading HIV researcher, educator and clinician in Toronto has followed the history of HIV/AIDS, both of its devastation and breakthroughs in treatment.
She was frontline during the AIDS crisis of the 1980s and 1990s, at the bedside treating patients and witnessing people die rapidly from it.
In the early 2000s, she oversaw testing antiretroviral drug clinical testing, which turned the disease from a death sentence to one manageable with treatment and with better life expectancy.
Frontline fighting AIDS
In the first decade of her career, Dr. Walmsley worked in the grim setting of the HIV ward at the height of the AIDS crisis.
By 1990, there were 526 known fatal cases of HIV/AIDS in Toronto, with its gay and Haitian communities hardest hit. Individuals with HIV dealt with deep stigma, due to the virus' association with drug use and homosexuality and the public's misperceived fear of easy infection.
"Health care professionals were gowned, gloved, masked, held their breath, and washed their hands in bleach on the way out of patient rooms," Dr. Walmsley recalls of hospital visitors and even some staff.
"Patients were treated like they had the plague."
Modern medicine at the time didn't have answers, and the high death toll made Dr. Walmsley's job emotionally taxing.
"At the beginning, there was nothing to offer. We didn't have treatments," she says. "I spent most nights sitting on someone's bedside watching them die."
Doctors had to be a caregiver, a friend, an unbiased person they could talk to, and their sounding board, Dr. Walmsley says. They also had to be advocates – both to hospital personnel who didn't understand the disease and to the public.
She has worked together with community advocates, many of whom were also her patients.
"They were loud and strong and yelled at everybody," she says. "They yelled at us too. It was often a challenge to earn their trust and get them to see that we were on their side."
But they were above all inspiring – exuberant, witty and passionate in the face of terminal illness, she says. They were instrumental in driving change in research and the drug approval process.
Research gives hope
Dr. Walmsley says a career watershed moment was at the 1996 International AIDS Conference in Vancouver, when a clinical trial unveiled to the world the potential impact of combination drugs – the so-called AIDS cocktail – that was able to suppress viral replication and helped to turn HIV/AIDS from a death sentence to a controllable illness.
"As we watched the data, jaws were dropping," she recalls. "That moment chilled everybody and gave new hope."
Following the introduction of combination therapy, which uses together different drugs to dampen the virus' effects and strengthening the immune system, infection and death rates began dropping in North America and elsewhere.
Walmsley spearheaded clinical trials and the introduction of new antiretroviral drugs at TGH in the early 2000s.
"We've moved from having to say, 'Listen, you're going to die in six months,' to advising those infected with HIV that life expectancy was normalizing in those with good adherence to therapy," she says.
Dr. Walmsley joined TGH in 1992, as a clinician-researcher. In 1995, Canada's first dedicated HIV/AIDS clinic opened at the hospital, which Dr. Walmsley helped set up. She has built a strong research team dedicated to conducting clinical trials in those living with HIV.
Dr. Walmsley's research has "followed the epidemic," she says. Before antiretroviral drugs became available she studied the management of opportunistic infections – infections arising due to a weakened immune system in people with AIDS. When drug treatments became available, she examined strategies on how to use the drugs properly and to minimize their toxicity.
Now, Dr. Walmsley is examining simplified therapies in clinical trials – fewer drugs for patients to keep the virus under control and new drug delivery options such as by injection. She is also assessing management of viral co-infections – for example, people who have both HIV and Hepatitis C in their body.
Much of her new work also entails understanding and optimizing care for people aging with HIV – something she didn't expect to be dealing with two decades ago.
Over her career, she has emphasized the importance of addressing gender difference in HIV research. She said most clinical trials involve young gay men, and the extrapolation of the findings to women may not always be appropriate.
"Are the medications and doses the same for women? Do they work differently or cause different side effects?" she says. "I wanted to make sure research included an adequate number of women were specific to women so we can address their unique health care needs."
She co-chairs an international workshop on research in HIV and women and has long advocated the need to establish treatment standards and protocols for women living with the virus.
A career well spent
Despite incredible advancements in research and treatment and hard fought victories by advocates, Dr. Walmsley cautions that problems still persist – especially with access to treatment and prevention.
"I think the public perception is that the HIV problem is resolved," she says. "It has not gone away, and the incidence of HIV, particularly in this city, has not declined over the past two decades."
One of her major joys has been in her education of healthcare professionals from many disciplines on the optimal care of persons living with HIV, locally, nationally, and internationally.
She has mentored many graduate students and doctors in research related to HIV – many of whom have gone on to become Canadian leaders in the fight against HIV.
She has particularly encouraged many women physicians to enter this area of research.
"I take great pride in watching the accomplishments of those that have trained and worked with me," she says. "My successes would not have been possible without the energies and the support of the persons around me."