Threat of HIV drug resistance looms large in Africa

Six million for new public-private partnership to develop
affordable test for HIV drug resistance
 
Press Release PharmAccess Foundation, February 6th 2008 

• The success of HIV/AIDS treatment in Sub-Saharan Africa is  threatened by  the development of resistance to commonly-used  antiretroviral treatment.
• The high costs and complexity of HIV resistance testing present a serious hurdle to selecting drugs for second-line treatment in Sub-Saharan Africa.
• An international research partnership wishes to change this situation and to enable affordable HIV resistance tests on the sub-continent.
• Innovative technological processes such as filter paper stored dry blood, blood samples by mail and the use of new laboratory techniques will be studied to develop a comprehensive new model for Africa.
• The project will also ensure Technology and Research transfer to help to build the healthcare infrastructure crucial to ensuring effective treatment in the future and to continuing the fight against HIV.

This major research project will be co-ordinated by the PharmAccess Foundation, affiliated with the Academic Medical Centre (AMC) in Amsterdam. The participating parties are the University Medical Centre Utrecht (UMCU), the Centre de Recherche Public de la Santé in Luxembourg and the University of the Witwatersrand in South Africa. The private partners are: Contract Laboratory Services in South Africa and Virco BVBA in Belgium, a company specialising in viral resistance.

The access of African HIV patients to antiretroviral treatment has greatly improved in recent years. Today nearly 1 in 3 African HIV patients in need of treatment has access to medication. However, there is uncertainty about the development of HIV resistance in Africa. “There are few viruses that mutate as frequently and easily as HIV. Doctors and patients rightly assume that antiretrovirals are effective. Yet if patients fail to adhere to the drug therapy, a new situation develops where the virus can rapidly become resistant”, says Prof Tobias Rinke de Wit, Program Director through the Center for Poverty-related Communicable Diseases (CPCD) at the Academic Medical Centre (AMC) in Amsterdam.

In the developed world HIV drug resistance is routinely tested for  through the use of advanced technology. “That is not currently possible in Africa”,says de Rinke de Wit.

Sub-Saharan Africa is the region worst-affected by the global pandemic of the human immunodeficiency virus (HIV). The support of large international donor organisations has resulted in the rapid increase of the availability of HIV-drugs over the past years. Yet the constant mutation of the virus enables resistant viruses to develop and these are no longer susceptible to the standard first-line combinations of HIV treatment. The success of HIV treatment in Africa is being threatened by the development of these resistant viruses.

Closely monitoring the effectiveness of treatment is difficult in Africa due to the high costs of regular blood tests, access to health care facilities and the lack of adequately equipped laboratories. Today the WHO does not advise to routinely test patients for resistance against antiretrovirals. “Yet those resistance tests are important for doctors to take the right decision on the most effective combination of HIV medicines for their patients in the event they don’t respond to regular treatment”, says Dr. Michèle van Vugt, Chief Medical Officer of the PharmAccess Foundation, the organisation coordinating the resistance test project.

In order to improve the research and test facilities for HIV drug resistance in HIV patients in Africa, a European Union and African research syndicate has raised 6 million Euros. Three million come from the Dutch Ministry of Education through NWO (Netherlands Organisation for Scientific Research/WOTRO Science for Global Development). The other 3 million Euro are invested in the project by two private partners, Virco BVBA, a Belgian based company specializing in HIV resistance testing and Contract Laboratory Services, a laboratory services provider affiliated to the University of the Witwatersrand, South Africa.

“We are very pleased to be able to contribute resources and expertise to this unique program which aims to develop an affordable, robust and accessible resistance test customised for Africa using both existing and new techniques”,says Werner Verbiest, General Manager Worldwide, Virco. According to Professor Wendy Stevens of the University of Witwatersrand .  “In this research program all phases necessary to enable the testing in Africa are being studied and mapped. We will analyze the complete process from taking a blood sample to the final interpretation of the test.”

The study includes questions such as: is it possible to develop methods on the ‘warm’ African continent to make redundant the ‘cold’ storage of blood samples? Could the transport of blood samples be simplified and accelerated? Could the sensitivity of the test be improved? The most current virus strain in the EU and the US is the so-called subtype B. In Africa different strains occur. Could the test effectively measure resistance in those African sub-types?”  John Dekker , Program Co-ordinator of the PharmAccess Foundation, adds “It is our opinion that the use of filter paper stored dry blood, more carefully chosen PCR primers, blood samples by mail and other biological techniques should make it possible to develop an affordable test method for Africa.”

For the press/ more information:

PharmAccess Foundation
Prof. Dr. T.F. Rinke de Wit
+ 31 (0)20 5667158
+ 31 (0)6 11303453

www.pharmaccess.org