Ravi R. Jhaveri, MD

Department / Division:
Pediatrics / Infectious Diseases

Address:
DUMC 3499
Durham, NC 27710

Appointment Telephone:
919-684-6335

Office Telephone:
919-684-6335

Fax Telephone:
919-668-4859

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

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

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

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

Research Interests:
My primary work is currently investigating the pathogenesis of steatosis in HCV genotype 3.  This project has involved cloning HCV genes from clinical samples and examining changes in intracellular lipid concentrations within liver cells after HCV protein expression.  We have focused on the Core protein and have discovered polyporphisms that correlate with clincal steatosis and cause increased intracellular fat to accumulate in transfected cells.  We have used site-specific and deletion mutagenesis to prove that these polymorphisms play a significant role in lipid metabolism.  
We have recently demonstrated that HCV Core domain 3 is sufficient for lipid accumulation.  We have also shown that it does not co-localize with lipid droplets when causing lipid to accumulate, a finding that is novel to the field.  Domain 3 does not cause ER stress when causing lipid to accumulate and it appears to partially co-localize to the Golgi apparatus.  At this time, we hypothesize the domain 3 alters lipid trafficking and we are actively performing experiments to support this hypothesis.
We have also designed recombinant adenoviruses expressing these steatosis-associated clones which we plan to use to infect primary hepatocytes.  We also hope to develop a small animal model system where infection of these adenoviruses leads to steatosis so that we can investigate the role of host factors in addition to the viral factors we have already identified.
This work is being conducted in the lab of Anna Mae Diehl of Gastroenterology/Hepatology.

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.
Fourth is I participate in phase 3 clinical trials to examine the efficacy and safety of Tigecycline in children 8-17 years old.

Representative Publications:
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

McGoogan KE, Smith PB , Choi SS, Berman WF, Jhaveri R.
“Performance of the AST to Platelet Ratio Index (APRI) as a Noninvasive Marker of Fibrosis in Children with Chronic Viral Hepatitis”, Journal of Pediatric Gasterogenterology and Nutrition, in press
(2009)

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

Jhaveri R, Qiang G, Diehl AM.  “Domain 3 of Hepatitis C Core Protein is Sufficient for Intracellular Lipid Accumulation”, Journal of Infectious Diseases, accepted
(2009)

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

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

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)

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

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)

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

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

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

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)