World AIDS Day: Reflecting on our commitment to fighting HIV and AIDS

Cape Town | The South African Medical Research Council (SAMRC) has been at the forefront of cutting edge research and innovation to tackle the HIV epidemic. On this 30th World AIDS Day, we commemorate the collective lives lost globally, while reflecting on the major strides we have made and our contribution and impact in HIV research.

South African scientists working with the SAMRC have ranked among the world’s best in all aspects of the HIV response, in the prevention of HIV infection from mother-to-child, the development of newer and safer drug regimens, and the health service delivery of antiretroviral treatment. To name a few: Professor Glenda Gray, the President and CEO of the SAMRC, Professor James McIntyre, Professor Jerry Coovadia and Professor Daya Moodley led the investigation of antiretrovirals to use for the prevention of mother to child transmission of HIV. Professors Robin Wood and Linda-Gail Bekker pioneered the delivery of ART at Somerset Hospital and the Gugulethu Community Health Centre almost twenty years ago and Professors Slim and Quarraisha Abdool Karim led world class research into the treatment of HIV and TB co-infection. Their breakthrough study on the use of Tenofivir gel presented at the Vienna AIDS Conference in 2010 marked a turning point in the use of antiretroviral agents in prevention.

South Africa has walked a long journey in the fight against the HIV epidemic with the SAMRC in tow, in fact Professor Malegapuru Makgoba, who focused on the immunology of HIV when he was at Oxford in 1982, stood up to the nation’s president at the height of AIDS denialism. He risked his position at the helm of the SAMRC. His courage at this critical point, set a path for the pursuit of science and truth.

The fight against HIV remains unfinished with an estimated 7.9 million people living with HIV in South Africa, coupled with 270,000 new infections and 110,000 AIDS-related deaths. As a responsive health organisation, the SAMRC today is involved in almost every aspect of HIV research, through our intramural and extramural research units and multiple grant programmes that fund university based researchers. We have global partnerships of which one is with the U.S. National Institutes of Health, where we currently co-fund 31 high-end HIV research projects engaging the latest science.

Through the government led roll-out of HIV testing, counselling, support and antiretroviral therapy (ART), life expectancy has increased and early mother-to-child transmission of HIV has plummeted. However, despite these and other efforts the HIV epidemic is not under control: about 1000 new HIV infections occur every day in South Africa. We need to scale up and improve the quality of key HIV-related interventions, including early diagnosis, linkages to care, counselling and support for ART adherence, preventing post-delivery mother-to-child HIV transmission and caring for the growing population of HIV exposed uninfected children. In addition to scaling up interventions, the SAMRC is researching new biomedical interventions such as vaccines and long acting injectable antiretrovirals for the prevention of HIV.

Funding health innovation in HIV research

Over the past decade, we have funded ground breaking research into several aspects of HIV and AIDS. A recent study conducted at the University of Witwatersrand was seeking to investigate a new low-dose formulation of Darunivar based therapy. This could have significant implications for South Africa’s current HIV treatment regimen with a goal of reducing drug-related toxicity, improving compliance and reducing costs.

A group at the University of Pretoria, led by Professor Michael Pepper together with colleagues in Switzerland have been working for several years on a gene-therapy mediated approach to curing HIV. A functional cure has been achieved in “humanized mice” and funding is now being sought to initiate a phase I clinical trial. We also fund a substantial national HIV vaccine development programme, with a selection of new vaccine candidates moving into preclinical development.

We are also supporting world class research on the evolution of broadly neutralizing antibodies in HIV-infected individuals and the application of this knowledge towards the development of new products for both active and passive immunization, this work is pioneered by Professors Lynn Morris, Penny Moore at the National Institute of Communicable Diseases, and Professor Slim Abdool Karim at CAPRISA. Further, the SAMRC’s support for novel drug resistance testing technology has led to scale up and introduction of the tool to substantially reduce the time and cost of HIV drug resistance testing.

Our work also demonstrated that HIV acquisition during pregnancy and lactation account for a significant proportion of infant infections. Thus, the SAMRC is co-funding an open-label randomised controlled study on immediate or deferred pre-exposure prophylaxis for pregnant and lactating women led by Professor Daya Moodley.

Steering health research from policy to practice

Our research has demonstrated the effectiveness of the national programme to Prevent Mother-to-Child-Transmission of HIV (PMTCT) at six-weeks and 18 months post-delivery, and has impacted national policy. Repeat HIV testing for HIV negative women and more frequent HIV testing for infants has been introduced by the National Department of Health. “It is important that we bring our research into possible prevention strategies to scale and ultimately impact on national health policy,” says Professor Gray.

A journey to find an HIV vaccine

Professor Glenda Gray, SAMRC’s President & CEO is also the Co-Principal Investigator of the international HIV Vaccine Trials Network (HVTN), a group of scientists who are dedicated to the discovery of an HIV vaccine. The SAMRC, with Professor Gray at its helm, is currently collaborating with international partners on two of the largest HIV vaccine trials in sub-Saharan Africa – HVTN 702 (Uhambo) and HVTN 705 (Imbokodo).   

In 2016, the SAMRC partnered with the P5, a public private partnership including the NIH and the Bill and Melinda Gates Foundation (BMGF) and the HIV Vaccine Trials Network (HVTN) and a number of researchers to launch the world’s first HIV vaccine efficacy study in seven years at 15 research sites across the country. The study, called HVTN 702, aims to establish whether an experimental vaccine regimen safely prevents HIV infection among South African adults. It involves a new version of the only HIV vaccine candidate yet shown to provide some protection against the virus and will complete enrolment of this trial early next year, making it the largest and most advanced HIV vaccine clinical trial to take place globally.

In 2017, the SAMRC in partnership with Johnson and Johnson, the NIH, the BMGF and the HVTN embarked on a new proof-of-concept study called Imbokodo, which is enrolling 2,600 HIV-negative women aged 18 to 35 years in sub-Saharan Africa.

This study is testing a number of two experimental vaccines to prevent HIV. “We are in the golden age of HIV vaccine science and hope to, in the next four years, be a game changer and bring valuable tools to the public to protect communities from HIV,” says Professor Gray.

The HIV Prevention Research Unit (HPRU) of the SAMRC is participating in a number of vaccine trials supported by our international partners. The trials are conducted among six different communities in the greater Durban area. “The participants and the community are fully supportive in our quest for an HIV prevention vaccine,” says Professor Gita Ramjee, Unit Director of HPRU. Results from both these studies (Uhambo and Imbokodo) are expected around 2020/21.

Biomedical prevention interventions against HIV/AIDS

HPRU conducts epidemiological, behavioural, basic science and clinical studies to investigate the vulnerability of women to HIV infection. According to Prof Ramjee, structural, behavioural and biological factors are important when considering HIV acquisition in women. As such, the Unit embarked on the ASPIRE trial, which was conducted at 15 sites in Uganda, Malawi, Zimbabwe and South Africa between August 2012 and June 2015. The aim of the study was to test the efficacy of a vaginal dapivirine ring in HIV prevention. It showed a 27% reduction in HIV acquisition among women using the dapivirine ring compared to women using a ring without dapivirine. In a second trial, The Ring Study, conducted at seven sites in South Africa and Uganda, showed a 31% reduction in HIV acquisition among women using the dapirivine ring.  

“It is the first time in the history of HIV prevention research in women, that a trial showed significant results in preventing HIV in women. More importantly the use of the ring was acceptable for use by women themselves as it is discreet,” says Professor Ramjee. “We hope that the ring will be an additional HIV prevention option to male and female condoms, PreExposure prophylaxis, using antiretroviral drugs and medical male circumcision among others.”