For the first time, HIV research is focusing on African patients. Fiona Tyrrell reports
To date, HIV research has mainly focused on the effects of treatments on people living in the west. However, an Irish-led research team in Uganda is set to evaluate HIV drug safety in African patients.
Of the 40 million people living with HIV worldwide, over 75 per cent live in sub-Saharan Africa. There are already over 12 million children in sub-Saharan Africa who have lost one or both parents to Aids and last year 25 million people in the region died long and difficult deaths - deaths that could have been prevented through access to HIV medicines and basic healthcare, according to Dr Ceppi Merry, a consultant in infectious diseases at St James's Hospital and one of the founders of the Irish-based HIV/Aids foundation, Réalta.
Merry, along with Dr Peter Coakley and Dr Mairín Ryan, also of St James's Hospital, is leading a team of 20 doctors and nurses from Uganda, Rwanda and Nigeria at a pharmacology clinic at the Infectious Diseases Institute in Makere University in Uganda.
They are now recruiting patients to begin work on an ambitious research programme to evaluate the safety of HIV medicines (antiretrovirals or ARV) in African patients.
There is essentially no data on the pharmacology of anti-retroviral drugs in African patients who are genomically, environmentally and behaviourally different to their western counterparts for whom the drugs have been developed.
HIV drugs were developed for American and European patients who live in different environments, have different diets and customs, and different drug processing genes, explains Merry, who is one year into a three-year leave of absence from St James's to work in Uganda.
The team hopes its research will help optimise and tailor HIV therapy to local populations and healthcare settings. Funding for the research programme has come from many sources including the Irish Government, the Irish Health and Research Board and the European Union.
The reality is that we know very little about how to treat HIV/Aids, according to Merry. "All we know is research done in the western world done primarily on men. We know very little about how to treat children or women, how to treat HIV and malaria at the same time and we don't know whether it is safe to use HIV drugs with TB drugs."
It is important to establish if the dose of HIV medicines being used in African patients is the most appropriate, Merry says.
If concentrations of ARVs in the blood are too low, this can result in the development of resistance of the HIV virus to those drugs and this makes them ineffective.
Concentrations of ARVs in the blood that are too high result in unwanted side effects.
One of the major obstacles to treatment and care in Africa is cost. Although the cost of HIV drugs has reduced significantly in recent times, they still remain unaffordable to most Africans with HIV.
The first research project to be undertaken by the team will investigate whether generic drugs are as good as patented drugs.
The next trial will test whether a new malaria drug recommended by the World Health Organisation is compatible with HIV medicines.
Other trials will investigate what is the appropriate dose of anti-retroviral therapy in a patient who is concurrently taking local herbal medicines or TB medicines and what is the appropriate dose of therapy in low-weight African adults and adolescents.
Merry got involved in the battle against HIV in Uganda four years ago following a work trip to Africa.
"I had been on holiday in Africa before but somehow I had never seen the poverty and I was horrified by all the children on the street whose parents had died from HIV."
Merry describes how she started to work on HIV in Ireland in the mid-1990s when the scenario was "very sad and depressing" but this changed with the arrival of new drugs.
"I realised that there is no reason why the same could not happen in Africa. They have access to Coca Cola, coffee and there is Guinness available on ever corner in Africa. Why is there no access to HIV drugs?"
The Réalta Foundation has been involved in a number of HIV programmes in Uganda, most notably a training programme at the Infectious Diseases Institute in Uganda, one of Africa's biggest HIV/Aids training centres. It also established the Aids Treatment Information Centre (Atic). The free call help centre for healthcare professionals treating HIV/Aids based at Mulago Hospital in Kampala receives calls from healthcare workers in 13 different African countries.
Work on another major Réalta project, the construction of a new hospital for the Mpigi area in Uganda, began last month.
This means that the estimated 10 per cent of the local population who have HIV will finally have access to life-saving medication.
For further information on Réalta activities, funding or employment opportunities, e-mail info@realtafoundation.ie