Validation of a new surrogate marker for AIDS progression and minimal essential monitoring for HIV-patients in Bangladesh

Issue: Since the identification of the Human Immunodeficiency Virus (HIV) as the causative agent of AIDS, dramatic progress has been made in the care and treatment of HIV patients. Introduction of highly active antiretroviral therapy (HAART) has changed the course of HIV from a lethally infection to a treatable disease. Availability of monitoring clinical status of HIV patients and functioning health systems are essential for providing optimal care and treatment for HIV-patients. Most of the above is well established in the Northern hemisphere, but in sharp contrast neither antiretroviral therapy, disease monitoring nor adequate clinical care have become available yet to most HIV-patients in countries with limited resources. These countries have to bear with the vast majority of HIV-patients and innovative approaches have to be taken to reduce the enormous socio-economic burden associated with the AIDS-pandemic.

Action: The development of new and cheaper tools for treatment monitoring in recent years finally enables countries with limited resources, like Bangladesh, to scale up HIV-monitoring. Our international research partnership ((I) Dr. Azim, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh: (II) Dr. Stoeckle, Ifakara Health, Research and Development Centre, Ifakara, Tanzania; (III) Dr. Klimkait, InPheno, Basle, Switzerland and (IV) Prof. Schüpbach, Swiss National Centre for Retroviruses, Zürich, Switzerland) was established by the end of 2005 with the aim to start minimal essential monitoring for HIV-patients in Bangladesh and validate a new test as an cost-effective alternative for treatment monitoring. This ELISA (based on the viral protein p24) costs only 10% of the usual test and there is no need of a functional cold chain. Most importantly, it will allow us to monitor for the emergence of drug resistance in HIV-patients. Treatment is becoming more and more available in Bangladesh, but until today we have absolutely no information about resistance. Based on this new tool we will able to change the antiretroviral treatment whenever it is indicated. We are currently carrying out a pilot study comprising 60 patients.  An essential part of the project is to test whether the drugs used in Bangladesh are still effective against HIV. We are now planning to move into a larger feasibility study and expand our services outside of Dhaka.

Impact: This new and unique minimal essential monitoring for HIV-patients in Bangladesh will lead to increased number of HIV-patients and is the foundation for urgently needed adequate clinical care. We want to build up a regional centre of excellence for HIV-disease monitoring at ICDDR,B and to act as the key national institute in charge of quality control and training of clinical and laboratory staff. Thus, the proposed research will become an essential research arm of the implementation of the national HIV control program. Scaling up clinical care for HIV-people in low-endemic countries like Bangladesh which have not been in the focus of the research community in the past is urgently needed. Bangladesh is still experiencing concentrated HIV-epidemic in most at risk groups and all combined efforts might prevent the spread of HIV into the general population of the most densely populated country in the world.

For further information about this long-term North-South clinical research partnerships please contact:
Lars Henning,
MD PhD, Swiss Tropical Institute, Socinstrasse 57, CH 4002 Basel, Switzerland

 

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