Chief of Clinical Hepatology, San Francisco General Hospital
Co-Director, Clinical and Translational Science Institute (CTSI)-Comprehensive Mentoring Program
Unit Director, CTSI- Mentor Consultation Services
My research focuses on natural history of chronic viral hepatitis (hepatitis B and hepatitis C), Alcohol-induced liver injury and pathogenesis of alcoholic and non-alcoholic fatty liver disease, novel treatments for viral hepatitis and fatty liver disease, health services/health disparity in liver disease, and evaluation of metabolic abnormalities within the context of alcohol-related liver disease, fatty liver disease and viral hepatitis (with and without HIV coinfection). My group previously evaluated mechanisms of insulin resistance and secretion in a large cohort of hepatitis C infected patients and Latinos with and without HCV infection, and is now examining how alcohol affects insulin action among the high risk populations. We are studying insulin action in adipose tissue, muscle and liver over time, using direct measures of insulin secretion and insulin action. We are also studying the mechanisms of immune response and influence of microbiome dysbiosis on metabolic parameters. We have evaluated impact of coexisting nonalcoholic and alcoholic fatty liver disease on chronic hepatitis B infection. As one of clinical centers of the large NIH-funded Hepatitis B Research Network, we are evaluating the natural history of chronic hepatitis B infection and optimal hepatitis B management in several prospective cohorts. Through our community and participatory research at Zucherberg San Francisco General Hospital we evaluate hepatitis B screening, management and liver cancer screening practices in hepatitis B-infected underserved populations including the impact of liver cancer screening on mortality. Our focus on health services and implementation science research involves evaluation of the impact of educational interventions on patient and provider knowledge, attitudes, and barriers to hepatitis C, hepatitis B, and fatty liver care as well as primary care-specialist care coordination and access to care for viral hepatitis and nonalcoholic and alcoholic fatty liver disease. In addition, we have implemented an infrastructure for hepatitis C screening and treatment within homeless shelters in San Francisco and nationally and continue to evaluate best practices in scaling up hepatitis C management in persons who inject drugs and homeless residents.