In between treating more than 300 mostly poor Hispanic and African-American men and women with HIV/AIDS and teaching at the UCLA School of Medicine, Dr. Daar has spent hours studying HIV/hepatitis C and investigating HIV complications such as HIV-associated wasting, lipodystrophy, cardiovascular disease and depression.
Dr. Daar also volunteers as Medical Director for the LA Shanti PLUS Program, which provides support for newly infected HIV individuals, and the Heart Touch Project, which offers free massage therapy for those living with HIV/AIDS. Throw in a decade of service to AIDS Project Los Angeles, where he also serves on the board of directors, and it's no wonder he is revered in the HIV/AIDS community.
"Dr. Eric Daar stands for everything good in this world," writes one patient of 11 years, detailing Dr. Daar's tireless efforts traveling the country to remind doctors, nurses and the general public, "the AIDS crisis has not passed; it's changing." This patient also describes Dr. Daar's caring treatment not only for his HIV but for associated problems, including hepatitis C and mental health issues.
"There needs to be more attention to the psycho-social issues related to HIV," says Dr. Daar. "These underlying problems -- such as psychiatric disease, drug abuse and alcoholism -- undermine physical health, compliance with drug treatment, and general caring for the self on the part of patients, which includes such things as simply showing up for doctor appointments and getting scheduled blood tests."
Dr. Daar raises alcoholism as an important but often overlooked factor that affects HIV treatment in multiple ways.
"Drug regimens must work around the presence or possibility of liver disease," he explains. "You're going to have trouble just remembering to take your drugs when you are supposed to if you are drunk. You're likely to forget medical appointments and may be more inclined to engage in risky behaviors.
"Honestly, I believe we have the ability to treat every patient with HIV successfully," he says. "The reason we aren't always successful is largely due to these underlying psychosocial factors."
One way to address those issues is to understand them, which is why Dr. Daar urges his patients to enroll in his HIV Natural History program. In this study patients are asked to supply in-depth information about their background, past experiences and behaviors. "By sharing their lives, they are not only helping themselves but helping others," says Dr. Daar, since the information may lead to prevention and research ideas. "It's what you learn from the patients that leads you to the questions that still need to be answered in the lab."
How long have you been practicing?
I finished my fellowship in 1991 and have held academic positions since that time.
Can you describe how your work has changed since you started?
I have continued to be involved in research with the main change being the addition of work related to the interaction between HIV and HCV infection. Clinically, the change has been dramatic. In the early years we offered little beyond prophylaxis and treatment for opportunistic infections along with comfort measures for those with advanced stage AIDS. In the last 10 years the focus has been toward managing the ever-increasing complexity of out-patient HIV care.
What's your official job title?
I am director of the Division of HIV Medicine at Harbor-UCLA Medical Center in Torrance, California. I can be described as a "clinician-investigator." I devote 50 percent of my time to research, 30 percent to patient care and 20 percent to teaching. I work with AIDS Clinical Trials Group, The Acute Infection and Early Disease Research Program and the NeuroAIDS Tissue Network doing research on HIV coinfections and complications.
Can you tell me specifically how crystal methamphetamine (meth) has impacted patients already infected?
My experience is that meth is highly addictive and results in people missing appointments, missing drugs, placing others at risk for HIV and frequently prevents them from being successfully treated for their disease.
Are you seeing more patients testing positive because of meth? Tell us a little about what you think is going on and which group is particularly affected.
In our effort to identify subjects with primary (new) HIV infection, we have the opportunity to ask them how they believe they became infected. In our experience, the majority link the time of their likely exposure to the use of drugs, with meth being far and away the most common of these drugs.
What kind of immigrants do you see in your clinic?
We see people from all over the world, but living in Los Angeles they are mostly from Mexico and Central America.
What happens if someone is illegally in the United States. Can they get treatment?
Many people receiving care in our clinic are in the United States illegally.
What's the best thing about your job?
My job has allowed me the opportunity to have extensive patient contact while continuing to pursue fundamental research questions. As a clinician-scientist it is clear that the most important research questions come from our direct experience with patients.
What's the worst thing about your job?
Because of new exposures, such as crystal meth drug abuse, there is some frustration that we haven't been able to stem the spread of HIV.
What have been your greatest successes and failures in your work?
The greatest successes for all of us taking care of people with HIV during the last 15 years have been the improvements in management that have allowed us the opportunity to enhance the quality and quantity of their lives. The failure relates to our continued inability to curb the spread of infection and increase the number of infected individuals getting tested and into care.
What is the biggest challenge you face as a clinician?
The greatest challenge I face as a clinician relates in part to the complexity of current HIV management and the many uncertainties about optimal care. This is compounded by the fact that HIV treatment is so unforgiving, with every mistake we make as clinicians persisting in our patients in the form of toxicities of drug-resistant virus. The latter aspect is unique to the management of HIV.
What do you think are the biggest problems people with HIV face?
The biggest problems facing people with HIV are dealing with uncertainty related to optimal treatment strategies, managing multiple diagnoses (e.g., drug use and psychiatric disorders) and assuring themselves that they are accessing expert care.
For the most part, what do you think is the biggest risk factor for HIV?
I would argue that it relates to the prevalence of drug use and psychiatric illness in society.
Do you think that the prevention efforts are sufficient? Anything you would change?
Prevention efforts need to focus on the underlying problems, which are much greater than education. This includes empowering women to be able to negotiate relationships with men and enhancing resources for the treatment of substance abuse and depression.
What education or counsel do you provide to newly diagnosed patients?
One of the unique things we do in terms of support and counsel actually has a dual purpose. We offer enrollment in a Natural History program, this is the NIH-funded Acute Infection And Early Disease Research Project (AIEDRP). In this program care providers, social workers and I spend hours over the course of weeks and even months talking with patients
If you were infected with HIV today, at what T-cell count would you begin treatment?
This is a complicated question that I am frequently asked. At this time I would start thinking about therapy when my T-cells were approximately 350 and would not feel compelled to start until they were consistently less than 300. My state of mind at the time I was making this decision would largely define when I would actually start.
What's the key to a great healthcare provider/patient relationship?
The patient needs to feel that the healthcare provider is their advocate and is not judgmental. Patients need to feel comfortable sharing any and all aspects of their life with their provider and know that the provider will be there to help, not judge them.
How do you feel about patients who take a proactive role in their own treatment?
I absolutely encourage patients to be proactive in their treatment. It's their life.
Who was your all-time favorite patient?
This is an unfair question, but hard to resist. There have been many but the one who comes to mind was an individual I met many years ago with very advanced disease. He had a remarkable spirit, as have many of my patients, and no matter how bad things were when asked how he was doing he responded "pretty good," as if almost to say, "believe it or not." He was like this for years and when I went to see him literally on his deathbed in his home in the last hours of his life, he lay in bed sapped of all of his strength and when I asked him how he was doing, he weakly opened his eyes and said, "Pretty good, Eric."
What is the most useful thing you have learned from your patients?
To listen to them, because they are usually right!
How do you maintain a positive outlook and avoid burning out?
I have had the opportunity to live through many changes and advances in the disease and to work with outstanding colleagues both locally, nationally and internationally who keep me thinking and challenged. Moreover, the unique opportunity my patients have provided me to be a part of their life has continued to be highly rewarding in situations when things are going well and when they are challenging. The human spirit I see in my patients makes my job seem easy.
If you weren't a clinician, what would you be? Why?
Well, I'm a clinician-investigator and I can't imagine being anything else. I want to do this forever.
Who would you like to dedicate this award to?
No question, the hundreds of patients that have allowed me to be a part of their lives and who have taught me so much. For a clinician-investigator, it's what you learn from the patients that leads you to the questions that still need to be answered in the lab.
We'd like our readers to get a sense of you as more than just a clinician. Could you share a little personal information about yourself? Where did you grow up?
What kind of work do your parents do?
My father is a lawyer and my mother a housewife.
What did you want to be when you were a kid?
A physician. As far back as I can remember. Maybe sometime when I was little I thought about being a baseball player or a fireman. But definitely by the time I reached high school I was determined to be a doctor. In college, I was a biology major.
What made you decide to go into HIV care?
I was in medical school when the syndrome now known as AIDS was first described. I was fascinated by infectious diseases and this was clearly an extraordinary problem. As a future internist this disease was particularly interesting because it was killing my peers and was scientifically in its infancy. The opportunity to do research in this area while directly interacting with patients suffering from the disease was a unique opportunity.
Who were the most influential people in your life, both professionally and personally? Why?
What do you do in your spare time?
I wake up at 3 a.m. at least Monday through Friday and go to the gym three to four days per week for exercise. Weekends, I wake up usually at 4-5 am. I tend to go to sleep at approximately 10 pm each night (when the kids let me). The time I'm not at work, I spend with my wife and four sons (17, 14, 8 and 4 years old) as well as my parents, sibling and extended family and friends. I also spend time working with a variety of organizations that serve the HIV-infected -- I'm on the board of the AIDS Project Los Angeles; medical director for LA Shanti and the PLUS Seminars; and medical director for the Heart Touch Project, which provides free massage for HIV-infected persons.
What specifically do you do for LA Shanti and for Heart Touch?
LA Shanti coordinates a seminar for newly HIV-diagnosed individuals called the Plus seminar. I am the medical director for this program and provide quarterly updates at their weekly seminars.
Heart Touch is an organization that trains and coordinates volunteer massage therapists to provide massage therapy to various groups, including those with AIDS. This project started approximately 10 years ago exclusively for AIDS patients. I have been their medical director since that time and provide an HIV/medical update, as well as information regarding HIV transmission risks to all of their new volunteers. Trainings occur approximately four times per year. In fact, I just returned from such a training.
Tell us a little more about your family.
My wife of 21 years is Judy Daar, a professor of law at Whittier Law School and clinical professor of medicine at UC Irvine School of Medicine, where she is on the Bioethics committee, performs bioethics consults and teaches. I have four sons: Evan (age 17, a high-school senior), Jared (14, a freshman), Adam (8, a third grader) and Ryan (4, a preschooler). Our pet dog is Kala, who is 12 years old, a pound puppy, we think part husky and part shepherd.
Where do you live?
Palos Verdes, in the southern part of Los Angeles County.
What's the biggest adventure you ever had?
My life, without a doubt. I get to work in an academic environment, do research on an intractable disease and still practice medicine in a county hospital and take care of poor people. Plus, I have an incredible wife and four children at various stages of life -- a challenge in itself. All in all, it's been a breathtaking ride.