SPOTLIGHT on Rachel Presti, MD, PhD
The Midwest D-CFAR community is full of brilliant and inspiring people, and we want to introduce them to the world! For our first spotlight, we are featuring Rachel Presti, medical director of WashU’s Infectious Disease Clinical Research Unit (IDCRU) and co-director of our Clinical Science Core. Many thanks to Dr. Presti for taking the time to speak with us!
Dr. Rachel Presti
Q: Could you briefly describe your career journey and research interests?
Dr. Presti: My journey began as an MD/PhD student at WashU in 1994, where I focused on viral immunology and viral latency. After completing my PhD, I returned to medical school and pursued a specialization in infectious diseases. During my postdoc, I explored the immunological aspects of infectious diseases, including some work on the microbiome and the virome, particularly in the context of HIV. As part of that research, we worked with people living with HIV to see how their immune system responded to new viruses.
This interest led me to join the AIDS Clinical Trials Unit (ACTU), which was started back in 1987. It was a pivotal moment in my career, as I realized I had a passion for working with patients and doing clinical trials. Eventually, I transitioned to running the Infectious Disease Clinical Research Unit (IDCRU). Initially, our focus was on AIDS clinical trials, but over time, we expanded our scope to include hepatitis C, vaccines, and even beyond to fungal and bacterial infections.
My work is deeply rooted in translational research, where I collaborate closely with folks in microbiology, immunology, and other basic science divisions. Where we have been most successful is working together to identify the questions they want answered, and then designing studies around these questions. Specifically, we do a lot of work looking at immune responses to vaccines and viral infections. Today, we remain an AIDS Clinical Trials Group site and have also become part of the COVID network. On the clinical side, we are involved with the Midwest D-CFAR, as well as the Center for Vaccine and Immunity to Microbial Pathogens (CVIMP).
Q: What was your experience like at the 2024 International AIDS Conference?
Dr. Presti presenting at the 2024 International AIDS Conference in Munich, Germany, on July 25, 2024.
Dr. Presti: This was my first time attending the AIDS Conference. What struck me most was the extensive involvement of the community. It’s clear that in order to continue making progress, we need to work closely with community members, acknowledging that they are the experts in their own disease. Hearing from them directly was a powerful reminder that community involvement has always been central to the research response to HIV. It was also inspiring to hear the new ways that people are thinking about cure and vaccines in the HIV space.
At the conference, I presented on a clinical trial using gene therapy to excise HIV DNA from cells - a potential step toward curing the disease. This was a first-in-human study, so our primary goal was to determine its safety, which it seemed to achieve. In terms of efficacy, there was one participant who showed evidence of excision and delayed viral rebound, which was encouraging, although we’re still waiting on more data.
Presenting this work was both terrifying and rewarding. I’ve presented to gene therapy experts before, but sharing this with HIV specialists was a different experience. In some ways, this has been one of the hardest studies I have done. It’s humbling to see the willingness of individuals to participate in these trials, understanding that while we have effective treatments, they’re still not enough. The fact that people are willing to take a risk and participate in cure studies is truly remarkable and inspiring.
Q: The D-CFAR has not even officially launched yet, but events have already started! Could you talk briefly about the THiS Studios you have organized and any other initiatives you are seeing come together?
Dr. Presti: One of the most exciting aspects of the D-CFAR is the opportunity to connect people. There are so many individuals in our region who are either actively involved in or interested in HIV research, yet often, they don't know each other or aren't aware of each other's work.
What I would tell people is anyone can do HIV research. We have decades of data thanks to the generosity of people living with HIV (PLHIV) sharing their time and their samples. If you’re interested in how people age, or how comorbidities come about, this is a very unique population to study. We've already identified several areas of interest among our researchers, and it's been thrilling to see different studios come together to explore these topics.
For instance, George Kyei, Elvin Geng, and I are leading a studio focused on global perspectives on HIV cure research. We want to identify what people worldwide want from a cure, and what possibilities exist in cure research.
Another studio, led by Burel Goodin, delves into chronic pain and sleep in PLHIV. Since Dr. Goodin is a psychologist, we can think about using cognitive behavioral psychology techniques to create interventions that might actually help people.
Beau Ances, Elvin Geng, and I are also exploring cognition and how inflammation impacts decision-making processes in PLHIV.
Finally, we're also looking at novel approaches to patient care in pharmacy, such as mobile pharmacy techniques, which have the potential to improve how people access services. Mike Durkin is involved in this effort, and it’s been incredibly promising so far.
Q: How do you think the new D-CFAR will contribute to the advancement of HIV research and programming in St. Louis and Missouri?
Dr. Presti: The new D-CFAR has tremendous potential to bring people together, creating a critical mass of individuals who are interested in advancing HIV research. Once we start seeing successes, it’s going to attract even more collaboration, both locally and beyond. We want to let people know that you don’t have to be an expert in HIV to do HIV research. Whether your focus is on sleep, mental health, smoking cessation, or comorbidities, there are so many ways to integrate these into the broader scope of HIV research. The impact of this isn’t just about addressing the HIV pandemic—it’s about improving health in the region overall.
We also aim to work with other CFARs, particularly those in the Midwest and the South, to improve HIV outcomes in regions of the country where the health systems, particularly from a public health standpoint, aren’t as robust as they are elsewhere.
For example, in St. Louis, we don’t have a strong infrastructure for tracking health data. It’s worth noting that St. Louis had the first documented case of someone living with HIV—a teenager who sadly died of opportunistic infections in the late 1960s. HIV has been in this region for a long time, often affecting populations that haven’t been well served by our healthcare system. So, we have a lot of work to do!
Q: You certainly have a lot going on with your work! What do you do in your free time?
Dr. Presti: I recently picked up playing the organ for my church. It's great because it keeps my mind busy - there is so much to think about while playing that I cannot think about anything else!
Written by Kate Gershwin.