Opinion by Dr. Roger I. Glass
Director, Fogarty International Center
During my trip to South Africa this spring in support of the Medical Education Partnership Initiative, I was able to witness some of the great work being done to prevent and treat HIV/AIDS. As we commemorate the 30th anniversary of the fight against this scourge, we acknowledge the advances against this and other infectious diseases by the National Institute of Allergy and Infectious Diseases (NIAID) and its director, Dr. Anthony S. Fauci, and by the many scientists around the world supported by NIAID and other institutes and centers of the NIH.
But if the great advances have been made standing on the shoulders of giants, in Isaac Newton's phrase, I think Fogarty has a hand - or a shoulder, perhaps - in a number of the research breakthroughs. Trainees supported through Fogarty-funded grants have helped contribute to the work that led to this progress. We're pleased to see our twenty-year investment in some of these developing country sites paying off with trainees who are well qualified to move forward the research funded by NIAID and others.
A singular breakthrough in the news is the study known as HPTN 052, which revealed that men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners through early initiation of oral antiretroviral therapy (ART). Fogarty grantee Dr. Myron "Mike" Cohen, who runs the Global Health Institute at the University of North Carolina, is the principal investigator of the study, funded mainly by NIAID with additional funding from other institutes.
This is the first randomized trial to definitively indicate that an HIV-infected individual can reduce sexual transmission of HIV to an uninfected partner by beginning ART sooner. This adds very strong scientific evidence that you can use treatment of HIV as an effective prevention modality by decreasing the possibility that a person who is infected unc
would transmit HIV to their sexual partner. More than 30 Fogarty-supported trainees in Malawi, India, Botswana and Thailand worked on the study.
Very recently, the conclusions of this discordant couples trial were buttressed by results from a pre-exposure prophylaxis, or PrEP, trial that showed that heterosexual participants who took a daily Truvada pill had a significantly lower chance of being infected.
Another landmark is the CAPRISA-004 trial, which demonstrated the effectiveness of an antiretroviral microbicide (tenofovir gel) in preventing sexually transmitted HIV infection in women. USAID funded the study, but Fogarty trainees authored many of the research papers and NIAID has long supported the site. The training was supported by a grant under Fogarty's AIDS International Training and Research Program (AITRP). Dr. Quarraisha Abdol Karim of Columbia University, who directed the CAPRIA study is the director of the AITRP grant and has mentored many trainees continuing this work.
Moreover, a site co-located with the Durban municipal TB clinic - and used in the CAPRISA study based at University of KwaZulu-Natal - is also one of eight sites for the ongoing NIAID-funded multi-country "VOICE" trial, which may help to confirm the outcomes of the CAPRISA-004 study. Fogarty trainee Dr. Kogie Naidoo said that a randomized clinical trial conducted at Durban demonstrated that antiretroviral treatment should begin at the same time as TB treatment. This result has caused the WHO to change its guidelines for TB treatment.
Finally, Dr. Sten Vermund of Vanderbilt University has directed a multi-country study, funded partly by NIAID with some Fogarty trainees participating, demonstrating the effectiveness of ART therapies in stopping mother-to-child transmission of the HIV virus. Sten's program has trained 64 individuals in degree programs, nearly all of whom have returned to their home countries.
There remains much to be done in the effort to achieve "a world without AIDS," in Dr. Fauci's phrase. As we mark the 30th anniversary of that effort, Fogarty is pleased to have played a significant role in training many of the researchers who are positioned to lead the battle.