The humble heart of the war on HIV

2014-11-03 11:00

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The only feature that distinguishes the building housing the Emavundleni Research Centre in Crossroads, Cape Town, from its neighbours is a fresh coat of paint and a neat palisade fence.

But this grey, two-storey building in one of South Africa’s most dangerous areas might soon become part of medical history.

Inside the centre, researchers are hard at work on a range of HIV-prevention studies: candidate vaccines, microbiocides – gels and vaginal rings containing different antiretrovirals – and pre-exposure prophylaxis (PrEP) trials.

So far, each of these interventions has shown positive results when tested for efficacy on humans. If they work, they have the potential to stop the spread of HIV and make the dream of an “Aids-free generation” a reality.

The PrEP trials have been particularly exciting.

It has been shown in several local and international studies that the regime can reduce the risk of HIV infection – in people who do not yet have the virus – by more than 80% if used correctly.

But it’s the latest findings from a vaccine trial conducted at the Emavundleni Research Centre last year that are causing a flutter among researchers.

The centre was one of three in the country which tested if an HIV vaccine called RV144 was safe, tolerable and induced an immune response among South Africans.

RV144 had already performed well in trials in Thailand in 2009. It had reduced the risk of HIV infection by 60% in the first year of vaccination and by 31% in the third year.

The news from South Africa was even better, with trials at Emavundleni, Klerksdorp and Soweto revealing that the vaccine induced a much better immune response in South Africans than it did among the Thai.

Professor Glenda Gray, director of the HIV Vaccine Trials Network in South Africa, could not contain her excitement when discussing the RV144 results this week.

Gray was speaking at the inaugural HIV Research for Prevention conference in Cape Town, and announced: “This brings us a step closer to finding a vaccine.

“The fact that the immune response of South Africans was as good, if not better, than those of the Thai gives us hope that the vaccine is closer than we think,” she said.

A stumbling block in finding a vaccine has been the nature of HIV – it constantly mutates and scientists have struggled to find a vaccine that can kill all strains.

The genetic make-up of different races and sexes and differences in body mass indices have also been a problem.

For instance, women respond better to vaccines than men, while obese people and alcohol abusers don’t respond well.

Gray said: “We feared that the response of South Africans may not be as good as the Thai because of our obesity levels. We were taken aback when we saw the results – this [response] is very unusual.”

Now she and her teams at Emavundleni and the two other sites are preparing to start another human trial in January. In this phase, 200 people between the ages of 18 and 44 will take part.

The trial will test the efficacy of the vaccine which has been modified to target HIV Subtype-C, which is prevalent in South Africa.

The Thai vaccine contained proteins that target strains which are more common in Thailand. The South African participants will first get a jab of the original vaccine used in the Thai trial. A year later, they will receive boosters containing the modified vaccine.

Dr Surita Roux, site investigator at the Emavundleni Research Centre, said she and her team were looking forward to starting the new trial.

Roux has been working in the field of HIV-prevention research for 15 years. She says conducting trials came with challenges – especially because of the stigma around the disease. But she does not think it will be difficult to recruit the 35 people Emavundleni must enrol for the upcoming trials.

She says it wasn’t always easy to get people involved.

“There were times when we spent six to nine months convincing people to participate in our trials,” said Roux.

“There were rumours that we took tons of participants’ blood and sold it. Others said we were infecting participants with HIV.”

But residents in Crossroads and neighbouring Nyanga have warmed to the modest centre with its big ambitions in the seven years that it has been operating, she says.

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