When Angela Kashuba joined the faculty at the UNC School of Pharmacy in 1997, she had some catch-up learning to do about her field of research—the pharmacology of HIV therapy. Ten years later, Kashuba’s research is helping to reshape policies and practices of HIV therapy and the prevention of the virus’s transmission.

Angela D. M. Kashuba, PharmD Associate Professor Pharmacotherapy and Experimental Therapeutics Research Interests Angela Kashuba's research focuses on the clinical pharmacology of antiretroviral agents used in the treatment of HIV infection. Specifically, she is investigating the role of antiretroviral therapy in preventing the transmission of HIV, determining optimal dosing and drug combinations for the treatment of HIV infection, understanding and predicting drug-drug and drug-cytokine interactions and adverse effects, and role of sex and ethnicity in drug disposition.

Not bad for someone who says she saw all of three HIV-infected patients during her fellowship.

Academic research wasn’t the career Kashuba initially envisioned for herself. After earning her bachelor’s degree in pharmacy at the University of Toronto, she worked as a clinical pharmacist for several years before going to the State University of New York at Buffalo for her PharmD. She thought she would return to Toronto (her hometown) afterwards and work as a clinical coordinator in a hospital, but her research experience at SUNY Buffalo persuaded her to pursue academic research instead.

So she did a fellowship at the Clinical Pharmacology Research Center at Bassett Healthcare in Cooperstown, New York, and then came to UNC as an assistant professor in the School’s Division of Pharmacotherapy and Experimental Therapeutics.

“Where I did my fellowship, we didn’t have a lot of HIV work that was going on,” says Kashuba, now an associate professor. “During my fellowship, as I started looking for my own research niche, I realized that there were lots of pharmacology and interaction questions about HIV. As I talked to schools in medicine and infectious-disease physicians, the pharmacology challenges were really in the HIV area.

“When I came here, I had a huge learning curve to get up to speed with how HIV was being treated, what the nuances are for HIV therapy, what all the toxicities were, what the pharmacology questions were. But after that, it really expanded because there are so many pharmacology issues in HIV.”

Kashuba proved to be a fast learner, and her work is now helping to find solutions to some of those issues. Her HIV research focuses on several areas: drug interactions, the use of drugs to prevent transmission, and pharmacology issues in HIV-infected women. Since joining the School, Kashuba has developed an internationally recognized HIV clinical pharmacology program. The program focuses on understanding and predicting drug interactions, optimizing therapy in special populations, and most importantly, understanding the pharmacology of small molecules and their potential use in HIV prevention stretegies. She has been awared more than $5 million in research grants and contracts. She has written more than seventy journal publications and eight book chapters and has also presented more than eighty peer-reviewed meeting abstracts.

In 2008 alone, Kashuba's group is initiating four new research studies in healthy volunteer men and women to evaluate six new drugs and different approaches to prevent HIV transmission. She is also initiating an animal model proof-of-concept study with the humanized mouse model for one of the promising compounds. Her group is also involved with ten other domestic and international pre-clinical, Phase I and II studies evaluating pharmacologic prevention approaches.

Click on the sections below to read more about her work.

Drug Interactions		Using Drugs to Prevent HIV Transmission		Preventing Mother-to-Baby Transmission		Treat the Patient, Not the Level		HIV in Older Populations		Working with Industry

"No One Is in a Silo"

Collaboration is a vital part of Kashuba’s work, and she says the collaborative atmosphere at UNC is a big reason she came to the University.

“The nice thing about working in the HIV area at UNC is we do have a Center for AIDS Research, and we do have funded cores,” Kashuba says.

There are eighteen CFARs across the country, which are funded by the National Institutes of Health. The UNC CFAR is a consortium consisting of UNC, the Research Triangle Institute, and Family Health International. Kashuba is the director of the UNC CFAR’s Clinical Pharmacology/Analytical Chemistry Core. Because UNC is the only CFAR with a very robust pharmacology core, other CFAR members often come to UNC to run their samples. The core also works with investigators in Haiti, South America, China, Korea, Africa, and the United Kingdom.

“We have everything from the basic science all the way to behavioral and outcomes,” Kashuba says. “It’s a very collaborative atmosphere, which is one of the reasons I came here. After I interviewed both here [at the School of Pharmacy] and with the School of Medicine, I realized that there was multidisciplinary translational research occurring here, and that was not happening at any of the other universities that I had interviewed at. No one is in a silo; everyone is very collaborative and interested in making your research better.”

That atmosphere, Kashuba says, also helps ensure that the research has practical applications.

“There’re lots of people who are thinking about the big picture and how your research question can actually impact policy or impact treatment strategies,” she says. “So that’s one way we’re thinking about research questions: Not necessarily answering a particular question because it’s interesting, but how is it going to impact the way we administer therapy to patients, either here or abroad.

“Everything that we do usually stems from a clinical problem or a clinical question, and we take it back, try to work it out, and apply it again. Everything is very applied, so it’s usually bedside to bench to bedside again, as opposed to bench to bedside.”