During my time as a John Monash scholar (2015 – 2018) I completed a Doctor of Philosophy (DPhil) at the University of Oxford. My research focused on the impact of early initiation of antiretroviral therapy on the host T cell response, from the perspective of developing an HIV cure. HIV is a chronic viral infection which, if untreated, causes destruction of the immune system and leads to AIDS. Whilst very effective treatments exist, these are not curative and must be taken for life. The challenge in curing HIV is that the virus leaves copies of its genetic material within the DNA of cells it infects. Therapy prevents the virus from multiplying within cells, but cannot remove this DNA which persists and, if treatment is stopped, provides a blueprint from which the virus comes back. In chronic viral infections and in cancer, one of the challenges is that the immune cells we rely on to fight these conditions develop a type of dysfunction known as “exhaustion”, a term that evokes inefficacy in the face of repeated attempts. It is felt that early after infection, before exhaustion sets in, may be a good time to target the immune response to help it to fight the virus. My work has aimed to characterise a number of aspects of T cell immunity in individuals who commence ART early during HIV infection. My findings have implications for how we measure the success of HIV curative interventions, and demonstrate an influence of immunologic events prior to starting ART on the eventual size of the HIV reservoir.
For me, the field has been so vibrant and exciting to be a part of because of the dedication and aspirations of those working in it, as well as the strong involvement of people living with HIV who want to see a cure. It is a field that, in my mind, should stand as an example to others in medicine for the way in which people affected by the virus are involved in helping shape research priorities and contribute to moving our understanding forward.
I am a medical doctor, and am currently completing specialist physician training. The decision to undertake my doctoral studies prior to the completion of my specialist training is, in Australia, an unusual one. Whilst I undoubtedly had support in this choice from my mentors, some people were concerned that in stepping off of the training path I would find it difficult to navigate my return. I have no doubt now that my path has provided me with skills in teamwork, in research and in listening to others that have made me a better clinician.
Coming back to Australia was an easy decision in the end. My period of time overseas really confirmed to me that in the long term it is Australia I want to call home, and that working towards positive change in a place that I love and care about is really important.
My return, however, had its challenges. For me, at the beginning of 2019, the change was enormous. I left a place that had really become my home with the community of people that were part of that and also changed my job. I went from a research role in which I had autonomy as well as some expertise, to come back to a very junior clinical role. And whilst that has been an entirely necessary step for my career, the sharpness of that contrast has been quite difficult. It is not really possible in Australia at the moment to combine specialist training jobs with substantial research time – so I have really needed to put my research activities “on hold” for a few years.
I am currently working as a Medical Registrar in Mildura, Victoria. I have really enjoyed living and working in regional Australia, and particularly the problem solving that practising medicine away from a metropolitan centre requires. The appearance of COVID-19 has changed the clinical environment and will continue to have impacts on the healthcare system for a long time; the uncertainty around how this virus will impact upon our futures weighs heavy. In my scholarship application I wrote: As a future clinician-researcher I hope to be able to bridge these two disciplines [clinical medicine and science], conducting research to find tangible solutions to clinical problems. This goal still resonates and I hope that the skills I have gained from my time overseas, and now as a clinician, will equip me to continue to work towards finding solutions to the infectious diseases challenges Australia faces.
Dr Genevieve Martin and Dr Luke Milross (2020 Roden Cutler NSW John Monash Scholar, currently working as part of the COVID team at Mildura Base Hospital) near Mildura.
About Dr Genevieve Martin
Dr Genevieve Martin holds a MBBS(Hons); BMedSc(Hons) and DPhil in Clinical Medicine. In 2013, she received the Monash University Distinguished Alumni student award. She is a recipient of the Wesfarmers John Monash Scholarship, which awarded in 2014 and supported her doctoral studies at the University of Oxford from 2015 - 2018. Her doctoral research has focused on the relevance of T cell immunity to HIV cure strategies. During her DPhil, Genevieve presented her work at several international conferences, and produced a number of first author publications. Dr Martin is currently working as a Medical Registrar at The Alfred Hospital in Melbourne, where she is also undertaking her speciality training with the Royal Australasian College of Physicians. She is working towards combining a career in clinical medicine with one in translational research, and is particularly interested in T cell therapeutics.