Meet Dr. Ian Sheffer
Ian G. Sheffer, MD, MBe, is an infectious disease specialist practicing in Center City Philadelphia. Dr. Sheffer provides primary care for people living with HIV at Drexel's Partnership Comprehensive Care Practice, and at the Dorothy Mann Center for Pediatric and Adolescent HIV. He is also the director of Drexel's outpatient Infectious Diseases and Travel Health clinic. In addition to his clinical appointments, Dr. Sheffer is an assistant professor at Drexel University College of Medicine.
What made you want to become a doctor?
It's hard to pinpoint exactly, but I did some volunteer work when I was in high school and I think that definitely pushed me in the direction of medicine.
I grew up in a family of skiers in central Pennsylvania. For as long as I can remember, my dad was involved with the ski patrol and served as an on-hill first responder. I got involved with the ski patrol when I was in high school, and that was my first experience with any sort of medical training. I didn't really think of it as a career option at that point, but I loved being able to help people and was interested in more in-depth training. During my freshman year of college, I took an EMT class to learn more first-aid, and while I was waiting for the class to start, another student asked if I was a pre-med student as well. At the time, the thought of going to med school literally hadn't even crossed my mind, but I was intrigued. Within a year I transferred to a different college and started down the path to medical school.
What sparked your interest in infectious disease?
I developed an interest in infectious disease when I was an undergraduate at UNC Wilmington. Since it's located right on the coast, most of the biology majors at UNC Wilmington aren't on a premed track, and most of the research activity focuses on marine biology. Because of this, I ended up doing research on water mold. I found myself really enjoying the parts of my undergraduate courses which were focused on microbiology, and as I thought more about my future, infectious diseases seemed like a natural fit.
As I made my way through medical school and residency, I realized that I wasn't drawn to any particular organ system. I like that infectious disease doctors work with diseases across all organ systems, age groups, and in all sorts of people.
What services do you provide at Drexel Medicine?
For twenty weeks of the year, I work on the inpatient consulting service at Hahnemann University Hospital. I see patients in the hospital who are primarily being cared for by other physicians—surgeons, obstetricians, gynecologists, internists, etc. I get called in when patients have a severe and or complicated infection, or for infections that may require outpatient therapy and extended follow-up. I also help if there's an issue diagnosing an unusual presentation of a common infection or a common presentation of an unusual infection.
On the outpatient side, I split my time between the Partnership Comprehensive Care Practice where I provide primary care for HIV patients and our Infectious Disease and Travel Health Clinic. The outpatient infectious disease clinic is where we see people for follow-up after they've left the hospital, and where we see referrals from physicians in the community. On the travel health side of things, we provide itinerary-specific pre-travel consultations for people who will be travelling to developing areas of the world, or to any place where there's an increased risk of disease. We help patients develop plans to avoid getting sick while they travel, and we also provide travel vaccines as needed. This can include typhoid fever, Japanese encephalitis, rabies, yellow fever, and more. We also see patients as needed for illnesses immediately after travel.
How far in advance should someone schedule an appointment with a travel health specialist?
I generally recommend someone schedule an appointment about two months in advance. We can provide general advice on mosquitoes and food-borne illnesses at any time, but in order for many vaccines to be effective, you need to get them well ahead of time. Some vaccines also require a series of injections over a period of time to provide protection, so the further in advance that can be planned, the better.
What kind of information should someone bring to a travel health appointment?
In addition to their travel itinerary, the most important thing to bring is a current list of your medical conditions, medications you take, and your past medical history. Vaccine records are also helpful if you have access to them. For the travel itinerary, you should include where you're going, how long you're going to be there, and what type of traveling you'll be doing. For example, a two-week stay at an all-inclusive resort is much different than a month-long mission trip to a rural area.
Do you have any general advice for staying healthy while you travel?
When it comes to travel health, common sense really does go a long way. The most common illnesses in travelers from the U.S. are related to contaminated food and water. The best way to avoid these illnesses is to eat fully cooked food, fruit that has a peel you can remove and discard, and to drink water that has been boiled or comes from a bottle where you're opening the seal. Certainly, staying in more upscale accommodations is probably going to be safer from a health standpoint, but that may not offer the experience you're looking for. Common sense and modern technology can be very helpful in creating the kind of travel experience you want. I generally tell folks that if a local place looks shady, it probably is, and if it has a line around the corner, that's probably not because folks are returning to get sick.
If it's available, use social media and the Internet to your advantage. See what other travelers have to say about places you're interested in before you go and you can likely avoid a lot of headaches.
Is Zika still something we should be concerned about?
It's still a concern, but thankfully we haven't seen a lot of transmission in the United States. The biggest concern as far as harm from the virus is, of course, the birth defects we've all heard so much about. Since there's no Zika vaccine yet, the current guidance from the CDC is mosquito avoidance. This means wearing long sleeves and using bug spray (with at least 20% DEET) in areas where you're at risk for mosquito bites.
One of the big concerns is sexual transmission of the Zika virus from someone who has traveled to an endemic area to someone who hasn't. The advice right now is for men returning from endemic areas to use barrier protection (condoms) for six months after they return. Women of childbearing age are also a big risk group because of the virus' potential to cause birth defects. The advice for those women is to not visit endemic areas if you're currently pregnant. If you plan on becoming pregnant, you should wait at least 2 months after your return, and use barrier protection during that time to prevent transmission. The recommendations can be a bit confusing, but the CDC's Zika website is a great resource and explains things very well.
Besides birth defects, are there any other ill effects from the Zika virus?
The birth defects have generated the most attention. There have also been cases of neurological disease due to Zika. For example, Guillain-Barre syndrome, which is an autoimmune neuromuscular disorder provoked by several different types of infections has been linked to Zika infection. Fortunately, most people who get Zika aren't going to get very sick from it. Only about 20-25% of people who are infected with the virus develop symptoms, and those are usually mild. The most common symptoms people develop are fatigue, body aches, an itchy rash, and a mild fever. For most these symptoms resolve quickly, and it is very rare for Zika to make someone sick enough to require hospitalization.
Shifting gears to your work with HIV, what makes the Partnership a good place for HIV care?
The Partnership is a great place for HIV care because it's incredibly well resourced and very experienced. We have several physicians, medical case managers, outreach staff, pharmacy support staff, clinic nurses, a behavioral health counselor, a dietician, and have been taking care of people with HIV for over 20 years.
We take care of about 1,700 people living with HIV, so we're a large clinic. Because of our size, we can offer walk-in care and same day appointments to new and established patients. Our academic affiliation with Drexel allows us to provide advanced, research-based treatment. We also have the resources to help our patients with everything from housing to setting up dental care, so we're really able to provide comprehensive primary care in addition to treating people's virus.
In your opinion, how has HIV treatment evolved over the last 30 years?
HIV is not the disease it was 30 years ago. We still don't have a cure, but with early detection and treatment, it's no longer a death sentence. I tell my patients that HIV is a disease you'll die with and not from. I have patients who have had the virus longer than I've been alive, and they're certainly thriving and not just surviving.
When we first started treating HIV in the late '80s and early '90s, the goal was to improve the survival rate at any cost. That meant you had a lot of very toxic medications with lots of side effects and a lot of drug-drug interactions. It also put a huge burden on the patient who had to manage very complicated medication regimens. Patients were commonly taking 15-20 pills throughout the day, every day. In the late '90s and early 2000s, the medications got a lot more tolerable and the regimens became simpler. Now we're seeing more and more one-pill-a-day options. Treatment has definitely come a long way, but there's still plenty of work to do. The next thing on the horizon, besides continuing to improve the single-tablet regimens, is going to be long-acting injectable medications where folks can get an injection of HIV medication once every few months. We're also making a big effort to get folks who may be at risk for HIV to start what's called PrEP, or pre-exposure prophylaxis. This is a one pill, once a day, regimen that's over 90% effective in preventing new HIV infections.
What are some of the biggest challenges in treating HIV?
We've become really good at treating HIV and reducing transmission. At a scientific level, we know how to stop the disease from spreading. The tricky part is identifying everyone who is infected and making sure they're able to stay on their medication. While the perception of HIV has improved in some communities, it still carries a stigma that discourages many people from getting tested in the first place. In a lot of ways HIV is still a disease of the disadvantaged, and so many of the challenges in treating HIV come not from the disease itself, but rather from the circumstances in which people living with HIV find themselves.
What do you like most about working at Drexel?
The collaborative atmosphere here makes this a fantastic place to work. I love that I get to work closely with all sorts of people to help our patients. Social workers, scientists, pharmacists, behavioral health therapists, medical educators, outreach workers, and of course our wonderful infectious diseases fellows, all make this a very fun and engaging place work. The diversity of experiences and close collaboration across disciplines certainly benefits our patients greatly, and I'm proud to be a part of Drexel Medicine.
Ian G. Sheffer, MD, MBe
Infectious Diseases, HIV
MD - Temple University School of Medicine (2011)
MBE - University of Pennsylvania (2011)
BS (Hons.) in Biology, BA (Hons.) in Philosophy and Religion - University of North Carolina at Wilmington (2007)
Partnership Comprehensive Care Practice
1427 Vine Street, 2nd Floor, Philadelphia, PA 19102
Drexel Medicine Travel Health
219 N. Broad Street, The Arnold T. Berman, MD Building, 6th Floor, Philadelphia, PA 19107
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.
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