JOURNAL INTERVIEWS - 2008

Founded in 1988, JAIDS is published by Lippincott Williams & Wilkins, a division of Wolters Kluwer Health. The journal takes a rather novel approach to its interdisciplinary subject matter, with an Editor-in-Chief to oversee each section of Basic Science, Clinical Science, and Epidemiology.

In the interview below, ScienceWatch.com correspondent Gary Taubes talks with Clinical Science Editor Paul Volberding about the journal's history and citation record.

How long have you been an Editor-in-Chief at JAIDS?

From the beginning, some 20 years ago. It’s important to point out that JAIDS has a pretty unique structure for a medical journal. We have three Co-Editors-in-Chief: one focuses on the basic science of AIDS; one on the clinical science—that’s me—and one focuses on the epidemiology and population science, including a lot of the prevention work we do. I’m the Clinical Editor-in-Chief of JAIDS, and I have been since it started. My counterparts are David Ho in New York, who is the Basic Sciences Editor-in-Chief, and Bill Blattner at the University of Maryland, who is the Epidemiology and Population Sciences Editor-in-Chief.

What do you think accounts for JAIDS's success and its increasing citation rate?

Our feeling is that we have a good structural approach to the decision-making in JAIDS, with three co-editors, and that that’s been paying off recently in what we’re able to accomplish—rapid response to publications, maintaining a fairly tight list of papers in process, offering the authors a rapid turnaround time from submission to publication. We think all that’s made the journal particularly attractive and we’re delighted to see that paying off.

So, bottom line, you’re getting better papers?

We’re getting better papers, absolutely. We’ve also really worked to increase the international feel of the journal. Our major competitor is seen more as a European-based journal, and historically has been somewhat more international in the sense of European authors. We’ve really worked hard to catch up with that. We think a lot of the best work is being done in Europe and elsewhere, particularly in clinical science.

Increasingly good clinical work is also being done in resource-limited settings. Right now I’d say a majority of the articles we get are either from Europe or Africa. And that’s been a change. We've really tried to stay ahead of that. We’ve tried to maintain a collection of reviewers who are from those areas, which we think, again, helps maintain that momentum.

What do you think is driving that trend in Europe and Africa?

The European investigators are quite nimble and they’ve had, perhaps, lower structural barriers to clinical investigation. It’s possible that the bureaucracy in some of these countries is a little more responsive than it's been in the US. The Europeans also have some very well-organized, large, and long-standing cohorts of HIV-infected patients, and those cohort studies have been a very important part in where clinical investigation is now.

In the earlier days of HIV, most of the progress was in direct interventional trials. As new drugs were brought on board and tested, both for HIV and the complications of immune deficiency, as therapy has become increasingly effective, a lot of the more important questions have shifted to what can broadly be described as outcomes investigations. There are large cohorts in Switzerland, for example, which contain essentially all the HIV-infected patients in that country. There are European collaborative cohorts that make up for smaller numbers in each country by joining those cohorts together. That’s one very important reason.

In terms of the lesser-developed nations, I think the field in the last five years has increasingly recognized that we now have the option of bringing antiretroviral therapies to many of these countries. That’s given rise to a large number of investigations, which have addressed variations in the epidemic, in strain differences in the virus, cultural factors affecting transmission, and specific disease manifestations.

As antiretrovirals have been introduced, researchers have addressed other very important questions that couldn’t have been done in the US. Here, these drugs were introduced piecemeal, first with one drug and then the next; in Africa, countries have effectively received the antiretrovirals all at once, and this has led to some very important work being done in the so-called immune response inflammatory syndrome, as patients treated with these antiretrovirals regain immunity and often develop immune reactions, sometimes destructive, against antigens present from opportunistic infections, for example. These have become very interesting, very important areas of research. And we’ve been seeing a number of excellent articles on that.

What we’re also seeing from Africa and Asia are studies of co-infections, particularly with tuberculosis, which has been a very important clinical problem. These are areas of research where, again, the lesser-developed countries are now leading the way.

Are there other specific areas of research or external factors that might be driving the rise in citation rates?

HIV medicine has also been really leading the way for the past 15 years in our understanding of how patients take their medications. As we developed more effective, but sometimes very complicated regimens of drugs, with the backdrop of drug resistance being such a problem, this has led to real advancements in the study of so-called medication adherence. It’s important in all medicine, but in HIV, the risks of becoming drug resistant make it a far more substantial problem. There’s been some really innovative research there, and it’s been a source of many papers.

The toxicity of drugs is another major topic. As HIV becomes a truly chronic disease, the duration patients must take their medications poses another real challenge—an interesting one. As drugs were approved quickly here, the risk that we might see unexpected toxicities with longer-term use is a real question. Again that’s a source of a lot of the research we publish.

How do you see JAIDS evolving in the next half-dozen years?

I personally think that our division into three broad topics has been a very healthy one for us. I think we will continue with that. We have had discussions internally about ways we might more explicitly address issues in developing nations, whether we should specifically identify review processes that might help get even more of that research to our journal. For the most part, though, we’re quite happy with how things are going.

Like many journals, we’re now an exclusively online submission and review journal. It took us a while to get that down, but it’s been a tremendous asset. We’re now able to track turnaround time and the quality of the reviews we get, and that’s been very important. I see the next few years as a process of further refining some of these things that seem to already be working quite well.

Another issue here is how journals will deal with real-time, online content. We try to move material online as quickly as possible, but we could probably still do better. That ends up being at some level a business decision, not just a reviewing question. But it’s the kind of issue we’ll be talking about a lot in the next few years.

What do you think the greatest challenges are in reviewing and publishing AIDS research?

I think one challenge for all journals is that we now live in an era in which information is so available, so out there, that we have to continually question the role of traditional journals. It's also a constant challenge to find people willing to spend the time and effort to give us a really meaningful, thoughtful review. That’s no different from the way it’s always been, but it’s a challenge that never goes away.

Another particular challenge we face in AIDS and HIV is that of a lot of important research comes in the form of descriptive information from these lesser-developed settings. We can’t really very effectively mentor those contributors from such a distance. So I think perhaps we may have to find better ways to publish research—venues for descriptive studies that might not otherwise fare well in a peer-reviewed journal. One possibility is to have open-access hosting of clinical experiences, whether in case-report forms or clinic-experience forms from a specific area. That could be quite useful.

What role do you think JAIDS plays in AIDS and HIV research? What do you perceive as its contribution to the field?

We’ve been, very obviously, an important specialty journal over a span of time that covers much of the history of AIDS—from a period when it was a rapidly fatal, non-curable disease. And we have been an active participant in helping develop the science that allowed it to become a chronic disease.

I think we’ve been a particularly important vehicle for American investigators. We’ve also had very close relationships with different NIH institutes; we’ve published supplements from the CDC, NIMH, and others. As such, our role as a collaborator with health-policy and research-policy organizations has made us productive in those areas, as well.

Is there anything else you would like to add or tell the general public about the work your journal does and publishes?

I think it’s heartening to know that there is still very active research interest in HIV and AIDS. We see challenges of continuing to improve the drugs and understand and reduce toxicities. One very important issue is that as these populations with HIV age with their disease, we will have to understand the very long-term effects of chronic infection with HIV. And there will also be other important areas for us to watch. The prospects are good for substantial research that requires the presence of a journal like JAIDS.

JAIDS—Journal of Acquired Immune Deficiency Syndromes
David D. Ho, Paul Volberding, and William Blattner, Co-Editors-in-Chief
Lippincott, Williams & Wilkins, publishers