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CL in Obstetrics & Gynaecology

Dr Joris Hemelaar (2019)

Pathway to a Clinical Lectureship

I studied for a BSc and an MSc (cum laude) in Molecular Biology and Genetics at Leiden University, The Netherlands (1997). I then came to Oxford to do a DPhil in Molecular Immunology with Prof Sir Andrew McMichael FRS at the Weatherall Institute of Molecular Medicine (2001). This was followed by post-doctoral research with Prof Hidde Ploegh at the Harvard Medical School, Boston, USA.

Having decided that I wanted to do medicine, I returned to Oxford and completed my BM BCh medical degree at Magdalen College (2007). Following my Foundation training in London, I successfully applied for an Academic Clinical Fellowship in Obstetrics & Gynaecology in Oxford, where I commenced my specialty training at the John Radcliffe Hospital in 2009.

In 2012 I was appointed as a Clinical Lecturer in the Nuffield Department of Women's and Reproductive Health, and in 2015 I was awarded the Sir Paul Nurse Junior Research Fellowship at Linacre College, Oxford.

What does the work involve?

My time is divided equally between clinical training as a specialist registrar and conducting research as a Clinical Lecturer. In my clinical training I specialise in Fetal Medicine and Advanced Labour Ward Practice, in which I focus on the antenatal management of fetal complications, often aided by ultrasound, and the safe delivery of babies.

My research focuses on HIV, both in pregnant women and the global epidemic. I lead a number of international collaborations and supervise a large number of undergraduate and DPhil students, and post-docs/research assistants.

I lead a research programme investigating the association of maternal HIV infection and antiretroviral treatment (ART) with adverse perinatal outcomes, such as preterm birth and intra-uterine growth restriction. I aim to dissect the epidemiological links between maternal HIV/ART and adverse perinatal outcomes and to elucidate the underlying mechanisms in order to develop novel predictive, preventative and therapeutic interventions applicable in the developing world. To this end I conduct systematic reviews and meta-analyses, a pregnancy cohort study in Soweto, South Africa (I hold an Honorary Senior Researcher position at the University of the Witwatersrand in Johannesburg, South Africa), and immunological studies on maternal blood samples collected throughout pregnancy. This work has already led to a publication in Lancet HIV.

The second line of research examines the global molecular epidemiology of HIV, through a collaboration with the World Health Organization, for which I am a consultant. The global distribution of HIV subtypes and recombinants is extremely complex and dynamic and has major implications for vaccine development, as well as diagnostic and viral load assays, which are crucial for clinical management of HIV. This work as led to a major publication in Lancet Infectious Diseases, which details the global and regional molecular epidemiology of HIV over the period 1990-2015.

Why Oxford?

As detailed above, I had existing links with Oxford through my DPhil and medical school. In addition, Oxford is the leading centre in the Intergrowth-21st consortium, which is an international collaboration which has developed international standards for fetal growth and investigates the conditions (risk factors, nutrition) which affect fetal growth and preterm birth. This fitted extremely well with my interest in the perinatal outcomes in women infected with HIV. Oxford also has a very strong immunology community, which is instrumental in my analysis of maternal blood samples to investigate the mechanisms leading to adverse perinatal outcomes, such a preterm birth.

May 2019