Four Questions with Tram Tran: Dedicated to Addressing Viral Hepatitis

Tram Tran, Vice President of Medical Affairs at Gilead, has devoted her career to helping people with liver disease, particularly those living with hepatitis B and C.

Prior to joining the company in 2018, Tram was the Medical Director of Liver Transplant at Cedars-Sinai Medical Center in Los Angeles as well as a Professor of Medicine at University of California, Los Angeles. She and her teams at Gilead work to study the global impact of viral hepatitis and medical interventions, help educate healthcare providers on caring for people with viral hepatitis, and create partnerships to establish best practices in elimination efforts.

We caught up with Tram to discuss what inspires her about working at Gilead, the impact of COVID-19 on communities affected by viral hepatitis and what needs to happen to make progress toward the World Health Organization’s goals of substantially reducing the number of new viral hepatitis infections and deaths.

Q: What originally motivated you to pursue a career in gastroenterology and transplant hepatology?
I actually was planning a career in law when I was in college, but the impact of chronic hepatitis B virus (HBV) on my own family inspired me to change course. We immigrated to the U.S. in 1975 from Vietnam, a country with high prevalence of HBV. We didn’t know it at the time, but my dad was living with HBV and was diagnosed at age 44. By the time he was diagnosed, he had developed cirrhosis and liver cancer. He ended up getting a liver transplant, but at the time, anti-viral medication for HBV was not available and he died of recurrent viral complications only a year later.

I decided then that I would go to medical school, work in viral hepatitis and liver transplant, and try to help improve outcomes for people like my dad. It has been an amazing journey for me and an incredible experience to be on that side of the medical advances in caring for people with liver diseases that we’ve seen in the last 20 years.

Q: What led you to again change your career path and join Gilead in 2018?
When curative hepatitis C virus (HCV) therapies were first being introduced by Gilead beginning in 2013, I can’t tell you how exciting it was as a clinician to be able to tell several patients every day that they were cured of this life-threatening disease. It’s just so rare in medicine that we can cure serious illnesses, and it was incredibly inspiring.

I also had the chance to be involved in clinical trials with Gilead and see how the company works. I trusted the people and the company’s approach to medicine, which has always been very science- and patient-based. When the opportunity with Gilead in Medical Affairs came up, I was excited about having the chance to help more people dealing with liver disease across the globe.

Q: How is the COVID-19 pandemic impacting people living with or at risk of acquiring viral hepatitis?
A lot of the challenges mirror those that we’re seeing more broadly in healthcare, with interventions such as elective procedures, routine visits and screening being paused for fear of exposing patients to COVID-19. The concern regarding people with viral hepatitis is that with reduced screening and deferral of routine appointments, people may not be diagnosed as early or fall out of care. That has the potential to impact outcomes for life-threatening liver and viral disease progression, liver cancer, and liver transplant. We’ve also seen that COVID-19 can impact the liver, which makes focusing on liver health even more critical.

It’s important that health systems find ways to continue screening and treating people for viral hepatitis during the pandemic. One silver lining is that the pandemic has pushed the global viral hepatitis community to move faster in a direction we were already heading. For several years there has been an initiative to move care outside of the hospital to clinics and non-traditional settings, where it’s easier to engage with hard-to-reach patient populations, such as individuals dealing with stigma, people who inject drugs or those with housing insecurity. The increased telemedicine we’re seeing today appears to have the potential to be another effective way of achieving this. I think we have an opportunity to identify some best practices now and continue to leverage them in the future.

Q: The World Health Organization has an ambitious goal of eliminating viral hepatitis as a public health problem. Goals include reducing new viral hepatitis infections by 90% and deaths due to viral hepatitis by 65% by 2030. What needs to happen to make that a reality?
We have to think bigger, beyond medicine. In HCV, there are now safe and effective curative therapies that we have studied in almost every patient population. We now need to work further on activating health systems and the patients within those systems to reach more people living with or at risk of acquiring HCV. An example of an innovative solution we’re exploring is using AI algorithms in electronic medical records systems to help better identify people who have previously been diagnosed with HCV to bring them back into care.

In HBV, the outlook is a little different because potential cures are still being researched, and that will take time. However, what already exists is safe and effective treatment that can buy time for those living with HBV, as well as a vaccine that can prevent new infections. We need to increase awareness of and access to these medicines while the science advancing potential cures progresses.

What’s most important is that everyone involved has a patient-centered approach. One of the reasons that even after joining Gilead I have continued to volunteer in the clinic several times a month is to stay grounded with patients. When I put on my white coat it brings my perspective back to how people experience these diseases and what really matters to them. Everyone I work with at Gilead operates from that frame of mind, so I’m optimistic about the possibility of one day eliminating viral hepatitis once and for all.