Physicians

Departments / Divisions

• Pediatrics / Pediatrics-Infectious Diseases
• Molecular Genetics and Microbiology

Address
DUMC 3499
Durham, NC 27710

Appointment Telephone
919-684-6335

Office Telephone
919-684-6335

Fax Telephone
919-668-4859

Training

• MD, Mount Sinai School of Medicine of New York University, 1996

Residency

• Pediatrics, University of Chicago Hospital (Illinois), 1996-1999

Fellowship

• Pediatric Infectious Diseases, Mattel Children's Hospital at UCLA (California), 1999-2003

Clinical Interests
Children with viral hepatitis (A, B, and C); research interest in children with hepatitis C exposure or infection, patients with problems related to general pediatric infectious diseases

Research Interests
My laboratory is involved in the study of Hepatitis C virus pathogenesis.  We initially began by studying alterations in lipid metabolism and steatosis.  We have recently shifted to examine the role of the Hedgehog pathway in HCV permissiveness.  We found that Huh7.5 cells, which are highly permissive for HCV replication, have very high levels of Hedgehog pathway activity and also have higher expression of mesenchymal markers.  This is in sharp contrast to most hepatocytes which have low levels of Hedgehog pathway acitivty and predominatly epithelial expression markers..  We have also used different pharmacologic agents to increase or decrease Hedgehog pathway activity and observed the corresponding effect on HCV replication.  These facts support the idea that HCV may perferentially replicate in a limited number of liver cells with increased Hedgehog activity that possess a less differentiated phenotype.  We are actively studying the key cellular proteins that may mediate this process.

Another line of research in the lab is probing the intracellular determinants of HCV vertical transmission.  We are examining key steps of the intracellular life cycle of HCV that have been identified in hepatocytes and using placental cell lines to investigate their suitability for sustaining/propagating HCV infection.  Our preliminary work indicates that HCV Core protein may be processed differently in placental cells, which we hypothesize may serve as a major block to new virus production.  We are initiating collaborations with investigators in Egypt to obtain placental tissue to perform additional studies to detect evidence of HCV replication in placental tissue.

This work is being conducted in close proximity to the core liver research labs, run by Anna Mae Diehl, chief of Gastroenterology/Hepatology here at Duke.

I also have clinical research interests.
One is the impact of Hepatitis C in infants and children.  I am particularly interested in the determinants of vertical transmission and the factors for resolution in HCV infection in young children.  We have begun a study examining the immune response in pregnant women with HCV and their infants to understand the dynamics of responses in the ante-, peri- and post-partum periods.
Two is the outcomes of children under 3 years old that present with fever to the urgent and emergent care centers.  Since the universal administration of Pneumococcal conjugate vaccine in 2000, there has been a significant drop in the rates of invasive penumococcal disease.  Our focus has been to re-evaluate the clinical paradigm in febrile children that calls for a complete laboratory evaluation and empiric antibiotics.  Our data thus far shows that all interventions except for urine cultures are no longer needed.  We will continue to evaluate for changes in this group.
Third is the investigation of increasing resistance patterns in E. coli infections in Pediatric patients.  A significant rise in TMP/SMX resistance has occured over the last 5 years that appreas to correlate with the rise in TMP/SMX prescriptions for MRSA disease.  We are investigating the nature of this relationship.

Industry Relationships and Collaborations (What's this?)

This physician has no reported relationships with industry.

Representative Publications
Arshad M, El-Kamary SS, Jhaveri R. Hepatitis C virus infection during pregnancy and the newborn period--are they opportunities for treatment? J Viral Hepat. 2011 Apr;18(4):229-36. (2011) Abstract

Choi SS, Bradrick S, Qiang G, Mostafavi A, Chaturvedi G, Weinman SA, Diehl AM, Jhaveri R. Upregulation of Hedgehog pathway is associated with cellular permissiveness for hepatitis C virus replication. Hepatology. 2011 Jul 25. (2011) Abstract

El-Kamary SS, Jhaveri R, Shardell MD. All-Cause, Liver-Related, and Non-Liver-Related Mortality Among HCV-Infected Individuals in the General US Population. Clin Infect Dis. 2011 Jul;53(2):150-7. (2011) Abstract

Reddick KL, Jhaveri R, Gandhi M, James AH, Swamy GK. Pregnancy outcomes associated with viral hepatitis. J Viral Hepat. 2011 Jul;18(7):e394-8. (2011) Abstract

McGoogan KE, Smith PB, Choi SS, Berman W, Jhaveri R. Performance of the AST-to-platelet ratio index as a noninvasive marker of fibrosis in pediatric patients with chronic viral hepatitis. J Pediatr Gastroenterol Nutr. 2010 Mar;50(3):344-6. (2010) Abstract

Patel K, Jhaveri R, George J, Qiang G, Kenedi C, Brown K, Cates C, Zekry A, Tillmann HL, Elliott L, Kilaru R, Albrecht J, Conrad A, G McHutchison J. Open-label, ascending dose, prospective cohort study evaluating the antiviral efficacy of Rosuvastatin therapy in serum and lipid fractions in patients with chronic hepatitis C. J Viral Hepat. 2010 Mar 29. (2010) Abstract

Pereira Tde A, Witek RP, Syn WK, Choi SS, Bradrick S, Karaca GF, Agboola KM, Jung Y, Omenetti A, Moylan CA, Yang L, Fernandez-Zapico ME, Jhaveri R, Shah VH, Pereira FE, Diehl AM. Viral factors induce Hedgehog pathway activation in humans with viral hepatitis, cirrhosis, and hepatocellular carcinoma. Lab Invest. 2010 Dec;90(12):1690-703. (2010) Abstract

Watt K, Waddle E, Jhaveri R. Changing epidemiology of serious bacterial infections in febrile infants without localizing signs. PLoS One. 2010;5(8):e12448. (2010) Abstract

Chancey RJ, Jhaveri R. Fever without localizing signs in children: a review in the post-Hib and postpneumococcal era. Minerva Pediatr. 2009 Oct;61(5):489-501. (2009) Abstract

Jhaveri R, Qiang G, Diehl AM. Domain 3 of hepatitis C virus core protein is sufficient for intracellular lipid accumulation. J Infect Dis. 2009 Dec 1;200(11):1781-8. (2009) Abstract

Lopez Marti MG, Jhaveri R. BACTEREMIA CAUSED BY AN ENTEROCOCCUS FAECALIS ISOLATE WITH HIGH-LEVEL LINEZOLID RESISTANCE IN A TEENAGER WITH CROHN'S DISEASE. Pediatr Infect Dis J. 2009 Jul;28(7):663-664. (2009) Abstract

Waddle EA, Hanson KE, Jhaveri R. Follow-up analysis of serious bacterial infections in children with fever without localising signs: how do the National Institute for Clinical Excellence guidelines perform with the emergence of non-vaccine pneumococcal serotypes? Arch Dis Child. 2009 Mar;94(3):247. (2009) Abstract

Jhaveri R, Bronstein D, Sollod J, Kitchen C, Krogstad P. “Outcome of Infections with Extended Spectrum Beta-Lactamase Producing Organisms in Children”, Journal of Pediatric Infectious Diseases, Vol 3 (4),2008: 229-233 (2008)

Jhaveri R, McHutchison J, Patel K, Qiang G, Diehl AM. Specific Polymorphisms in Hepatitis C Virus Genotype 3 Core Protein Associated with Intracellular Lipid Accumulation. J Infect Dis. 2008 Jan 4. (2008) Abstract

Qiang G, Yang L, Witek RP, Jhaveri R. Recombinant adenoviruses expressing Steatosis-associated Hepatitis C virus genotype 3 Core protein produce intracellular lipid accumulation in cultured and primary hepatocytes. Virus Res. 2008 Nov 13. (2008) Abstract

Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs post-pneumococcal conjugate vaccine. Arch Dis Child. 2008 Jun 6. (2008) Abstract

Waddle E, El-Yaman M, Jhaveri R.  “Frequency and Outcomes of Moraxella catarrhalis Bacteremia in
Children”, Journal of Pediatric Infectious Diseases, 2007;2:95-100
(2007)

Yang L, Jhaveri R, Huang J, Qi Y, Diehl AM. Endoplasmic reticulum stress, hepatocyte CD1d and NKT cell abnormalities in murine fatty livers. Lab Invest. 2007 Jul 2. (2007) Abstract

Jhaveri R, Grant W, Kauf TL, McHutchison J. The burden of hepatitis C virus infection in children: estimated direct medical costs over a 10-year period.  J Pediatr.  2006 Mar;148(3):353-8. (2006) Abstract

Grant W, Jhaveri R, McHutchison J, Schulman K, Kauf TL.  “Hepatitis C Healthcare Utilization
Trends in the United States”, Hepatology 2005 Dec;42:1406-1413
(2005)

Jhaveri R, Kundu P, Shapiro AM, Venkatesan A, Dasgupta A. Effect of heptitis C virus core protein on cellular gene expression: specific inhibition of cyclooxygenase 2. J Infect Dis. 2005 May 1;191(9):1498-506. (2005) Abstract

Slowik MK, Jhaveri R. Hepatitis B and C viruses in infants and young children. Semin Pediatr Infect Dis. 2005 Oct;16(4):296-305. (2005) Abstract