A life in paediatric HIV research and care: Prof Gareth Tudor-Williams retires

Professor Gareth Tudor-Williams

Professor Gareth Tudor-Williams has retired after a career spanning over three decades in paediatric HIV research and care.

In his introduction to Professor Tudor-Williams’ 2019 inaugural lecture, Professor Mike Levin remarked: “I can't possibly count or remember the number of countries and places that Gareth has been. But the people here who work in paediatric HIV will know that Gareth has travelled to far ends of numerous countries around the world to teach on HIV and to spread his clinical expertise and knowledge.”

From tackling preventable illnesses in the foothills of the Himalayas, to contributing to the development of life-saving treatments during the nadir of the US HIV/AIDS epidemic, Professor Tudor-Williams has dedicated his career to improving outcomes for children and young people with infectious diseases around the world.

But, as it turns out, this was not quite what he had in mind when starting out as a junior doctor.

“When I left medical school, I wasn’t sure what I wanted to do – I thought I wanted to do adult medicine,” he recalls.

“I ended up spending 18 months as a Senior House Officer in general medicine down in Exeter, and I fully expected the rest of my life to be spent in the West Country because I absolutely loved it.”

Taking a different track

Having enjoyed undergraduate paediatrics as a medical student, Professor Tudor-Williams moved to Bristol Children’s Hospital “to see if paediatrics was more fun than adult medicine” and was soon hooked.

After undertaking broad training in paediatrics at hospitals around the UK, Professor Tudor-Williams decided to up sticks from London to the Himalayas to work with Save the Children Fund in Nepal. It was this move, which saw him running a mother and child health clinic for two years, that began to crystallise his interest in paediatric infectious diseases.

“If you're out in the middle hills of the Himalayas, two days walk from the nearest road, you realise that the buck stops with you. You know you can't do an onward referral,” he explains.

“We were seeing outbreaks of measles and whooping cough and sporadic infant deaths from tetanus. All sorts of preventable illnesses were occurring all around me in this magnificent but crushingly poor environment. The experience really focused my mind on the burden of infectious diseases in children in low-income settings, and then I came back to a registrar job in Nottingham.” 

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Amongst other rotations, Professor Tudor-Williams worked for Nottingham’s regional oncology service, which involved treating children with acute lymphoblastic leukaemia, an aggressive form of cancer that affects the white blood cells. 

“We were really good at getting our patients into remission from their leukaemia but really bad at diagnosing the opportunistic infections that subsequently killed them.” 

“We were looking at lung biopsies post-mortem and realising that we just desperately needed better tools to be able to diagnose and treat these infections. It gave me a new perspective of infectious diseases in immunocompromised children.”

Professor Tudor-Williams went on to join Richard Moxon at the University of Oxford to run the first trial of a conjugate vaccine for H. influenzae type b (Hib) invasive disease – a bacterial infection that can cause a number of serious illnesses, particularly in young children. This work laid the foundations for the introduction of routine immunisation against Hib in UK infants in 1992. 

Tackling HIV infection in children 

In the late eighties, as the US HIV/AIDS epidemic was emerging, Professor Tudor-Williams relocated to the States to specialise in HIV infection in children. In June 1981, the first person with AIDS had been admitted to the Clinical Center at the National Institutes of Health (NIH), where Professor Tudor-Williams would later work. However, it would be six more years before US President Ronald Regan publicly addressed the domestic AIDS crisis. Between the first reported cases in 1981 to 1988, HIV/AIDS had become the third leading cause of death among US men 25-44 years of age and, by 1989, was estimated to be second, surpassing heart disease, cancer, suicide, and homicide. 

“At the time, in the dominant literature coming out of the United States, people with HIV were being characterised by ‘the four Hs’: homosexuality, haemophilia, Haitian origin, and high-risk behaviours (either commercial sex or IV drug use). There was very little focus on children.” 

Professor Tudor-Williams spent his first two years in the States as a Fellow at Duke University. There, he worked alongside Cathy Wilfert and Sam Katz, who were treating the first cohort of children in the world to receive the anti-HIV drug called AZT (zidovudine). He undertook pharmacokinetic studies of AZT in infants, which provided the dosing information for the pivotal ACTG 076 trial, published in the New England Journal of Medicine in 1994. This randomised controlled trial unexpectedly demonstrated that AZT given to mothers and their infants reduced mother-to-child transmission of HIV from 25 per cent to 8 per cent. 

Professor Tudor-Williams then spent three years at the National Institutes of Health as a Visiting Scientist and Attending Physician with Philip Pizzo, whose team pioneered the use of continuous infusion of AZT in children with HIV in 1988, which at the time represented a significant step forward in treating infection.

“The academic element of what we were doing was absolutely crucial to not burning out,” Professor Tudor-Williams says.

“If I was just simply trying to deliver care day after day to a cohort of very sick children with really poor drugs then I would have burned out years ago. But, if you are part of a program of rolling research that incrementally improves the outcome – you can see it, you can feel it, you know that progress is happening. Every five years you can reflect and say, ‘wow, we've come a long way’, and over the past 30 years we really have. The vast majority of children born today with HIV will make it through childhood to adulthood if there’s the political will.” 

A new chapter at Imperial

While working on various trials for new HIV medicines at the NIH, Professor Tudor-Williams was recruited by Imperial’s Professor Mike Levin and Dr Sam Walters, relocating to St Mary’s Hospital in 1994. 

“Mike had the vision to realise that we could be a centre for looking after children with HIV, and indeed their families. I came back and helped to set up the family clinic at St Mary’s, and we've looked after one of the largest cohorts of HIV infected children in Western Europe.”

Since joining Imperial, Professor Tudor-Williams has also played a major role in undergraduate education at the College, co-directing the Paediatrics course with Professor Mitch Blair for ten years. He received a prestigious ICSM Distinguished Teacher Award in 2017, which recognises individuals who have continuously delivered outstanding teaching over and beyond expectations. 

In addition to playing a leading role as a member of Penta (Paediatric European Network for Treatment of AIDS) – now a large-scale international collaboration for paediatric infectious disease research – Professor Tudor-Williams was also the founding Chair of CHIVA (Children’s HIV Association), which aims to enhance the health and social wellbeing of children and young people living with HIV in the UK and Ireland. Its sister initiative, CHIVA Africa, was launched in 2004 to build the capacity of healthcare professionals treating children with HIV in South Africa, particularly in the hard-hit region of KwaZulu-Natal. Here, Professor Tudor-Williams has worked with Oxford’s Professor Philip Goulder to investigate why, in rare cases, children with HIV infection are “natural long-term slow-progressors”, meaning that they do not develop AIDS during childhood. 

"I just know we have to go on advocating for these children.”  Professor Gareth Tudor-Williams

In recent years, Professor Tudor-Williams has also worked with WHO and UNICEF in the Sindh Province of Pakistan, where hundreds of children tested positive for HIV in 2019, largely as a result of unsafe reuse of injection needles. Sadly, little has changed in the two years since news of the outbreak gained international attention. 

“Frankly, what is happening there now is still unacceptable,” he says.

“Obviously, COVID has not helped, but health care services are not getting the support they need. The doctors who can help are not being treated well - it's a very, very difficult situation. More than 1500 children are known to have been infected with HIV and other blood-borne viruses. New cases are continuing to be identified. I just know we have to go on advocating for these children.” 

A legacy of survivors

Despite witnessing first-hand the persistent and fatal impact of ignorance and stigma attributed to HIV, it’s clear that Professor Tudor-Williams remains hopeful when it comes to the future of the field. 

“In HIV research, there are some really exciting opportunities on the horizon. The cure agenda is going to dominate the scientific work over the next ten years, and we're beginning to reach that point. We will be treating HIV very differently in ten years’ time. Right now, for young people living with HIV, distributing the best tolerated and most effective drugs to children in low- and middle-income countries and training health care personnel to give them is the priority, and that's a work-in-progress.” 

However, when it comes to acknowledging his own role in the progress of the last thirty years, he is quick to characterise himself as a minor figure in HIV’s history, referencing Spike Milligan’s book – ‘Adolf Hitler: My Part in His Downfall’. 

“The proudest achievement of my career has been the work I’ve done around HIV in children. I've witnessed the advances in managing HIV infection acquired in infancy, from mostly ending in death by the age of five, to young people moving forwards into their adult lives. If they make it into young adulthood, they will probably have a life expectancy that is not dissimilar to yours or mine. That is a completely extraordinary achievement that I don't take credit for, but it’s one that I participated in by supporting a myriad of research projects that have gone on over the years.” 

It seems important to note, then, that Professor Tudor-Williams’ own modest account of his impact is altogether different from the one given by his former patient, Sasha. Closing his inaugural lecture two years ago, Sasha – diagnosed with HIV aged five, now thriving with a family of her own – put it simply: “If it wasn’t for Gareth, there’s no way I would be here today. And I’m not the only survivor – I’m one of many.”

Professor Tudor-Williams would like to acknowledge every one of his colleagues in the Family Clinic and in the Paediatric Infectious Diseases team at IC / ICHT who have been such a tremendous support over the past 27 years, and the children and families for whom we have cared and who have taught us so much.

Image credit: A man with his wife and two sons with a message about the importance of being faithful to his wife to avoid putting his family at risk from AIDS; a poster from the America responds to Aids advertising campaign. Lithograph, 1991. Wellcome Collection. In copyright