The effort to bring effective therapies for HIV and AIDS to developing countries has received growing support within the past few years; however, the efforts to lower the cost of drugs has had little impact on increasing the availability of, or lowering the cost of essential monitoring tests. As a result, the availability of these tests is exceedingly limited in developing countries where the vast majority of HIV-infected people live. The Emory research team will work with scientists at the Ethiopian Netherlands AIDS Research Project in Addis Ababa and with investigators at Addis Ababa University Faculty of Medicine to adapt technologies already in use in the United States to clinical conditions in Ethiopia, as well as to derive novel monitoring strategies that are designed to be more readily implemented in resource-poor countries.
"The standard of care for monitoring antiretroviral therapy in the U.S. is based on tracking CD4 T cell counts and conducting HIV viral load measurements," explains Frances Priddy, MD, assistant professor of medicine in Emory University School of Medicine and a co-investigator on the Emory grant. "Our Emory team will take the technologies already used for these tests and simplify and substantially reconfigure them for countries where resources are scarce and where the electrical supply and refrigeration may be intermittent. We want to develop tests that can be used in resource-poor countries so they can also conduct high-quality monitoring of antiretroviral therapy."
"All of the ongoing efforts to make antiretroviral therapy available in developing countries will be compromised unless effective clinical monitoring tools to determine who needs treatment most and how well someone is responding to treatment are made available in these countries," says Mark Feinberg, MD, PhD, Emory professor of medicine and principal investigator of the Emory project. "At present, HIV therapy in developed countries can be highly effective when it is overseen by knowledgeable clinicians, with the support of state-of-the art clinical monitoring labs. Indeed, many lives are being saved as a result of therapeutic advances. However, both the antiretroviral drugs and the clinical monitoring tools are very expensive and complex to use. Further, the technology needed for contemporary clinical monitoring tools involves complex, expensive equipment that requires near-constant up-keep, and thus will be difficult or impossible to sustain in resource-poor countries. It is imperative that simpler and cheaper, yet reliable tests be developed to enable HIV-infected individuals living in developing countries to derive long-term benefit from the increased availability of antiretroviral therapies."
During the first year of the two-year project, the Emory investigators will work to develop the reconfigured technologies; then, during the second year, they will travel to Ethiopia to field test the new tools to determine their feasibility and effectiveness in the Ethiopian population and in HIV subtype C, the predominant HIV strain in Ethiopia. Subtype B is the predominant strain in the United States.
In addition to Dr. Priddy and Dr. Feinberg, the Emory team includes Angela Caliendo, MD, PhD and Sylvija Staprans, PhD.
If the pilot program is successful, the Emory scientists hope to test their tools in other countries and in larger groups of patients.