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Masur Delivers Astute Clinician Lecture

By Colleen Henrichsen

"AIDS: A Window on Infectious Diseases," was the topic of the fifth Astute Clinician Lecture presented by Dr. Henry Masur, chief of the Clinical Center critical care medicine department, on Nov. 6.

Masur's early career focused on intracellular protozoa and how they evade host immune response. He was a resident at New York Hospital in 1979, when a 27-year-old man with no known immunosuppressive condition was diagnosed with Pneumocystis carinii pneumonia (PCP). Masur recognized that there was little precedent for this occurrence.

"In the 1970's, only 70-80 cases were diagnosed a year. In adults, those usually occurred in patients with organ transplants or oncologic problems," he said.

Dr. Henry Masur

"When I presented this case at intra-city infectious disease rounds in New York, a number of hands shot up from other clinicians who had recognized similar cases." His report of this outbreak was one of three that formed the first published report of AIDS.

Masur moved to NIH in 1982 to expand his investigations. This included studies of why HIV patients had a poor survival rate. He found that organisms that were previously rarely recognized — toxoplasma, cytomegalovirus and mycobacterium avium — were frequent causes of illness and death in HIV patients.

He worked on improving methods of diagnosing and treating these complications. Masur and his NIH collaborators developed new diagnostic tests for PCP, new therapeutic agents and new management strategies. They developed and patented the most widely used laboratory test to recognize PCP, developed improved techniques for obtaining patient samples for testing and developed and patented a new agent to treat PCP.

Masur also led efforts to make this information useful. "It's important to make sure the health care community and patients are aware of advances so that they really change patient outcomes," he said.

To that end, he and his colleagues at NIH, with support from the Office of AIDS Research, established the PHS Guidelines for Prevention of HIV-related Pneumocystis Pneumonia in 1989, which were the first HIV-related guidelines. In 1995, the CDC and the Infectious Disease Society of America joined NIH as sponsors of these guidelines. The USPHS-IDSA Guidelines for Prevention of HIV-Related Opportunistic Infections are updated regularly. USPHS-IDSA Guidelines for Therapy of HIV-Related Infections will be published soon.

A native of Washington D.C., Masur graduated from Cornell Medical School. He trained in internal medicine at New York Hospital and Johns Hopkins Hospital and trained in infectious disease at Cornell, where he was on the faculty from 1978 to 1982. He came to NIH to become assistant chief of critical care medicine in 1982, and has held his current position as chief since 1989.

The Astute Clinician Lecture was established through a gift from Haruko and Dr. Robert W. Miller. It honors a U.S. scientist who has observed an unusual clinical occurrence, and by investigating it, has opened an important new avenue of research.

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