Researchers to Monitor Resistance to HIV Drugs in Africa

Researchers from the University of Pittsburgh School of Medicine are leading a five-year, $5 million initiative to monitor drug resistance during the rollout of HIV prevention drugs in sub-Saharan Africa.

Under the terms of a cooperative agreement awarded by the U.S. Agency for International Development (USAID), experts in the School of Medicine’s Infectious Diseases Division will conduct laboratory research and develop policy guidance for monitoring drug resistance during distribution of the drugs and microbicides that prevent HIV.

“HIV/AIDS is an epidemic in sub-Saharan Africa and, until now, we’ve been really focused on treating people who already have the disease. But to stem the epidemic, we also need to prevent new infections,” said Urvi Parikh, Pitt assistant professor of medicine and senior project advisor. 

About 25 million people have HIV in sub-Saharan Africa, accounting for nearly 70 percent of the global total.

Pre-exposure prophylaxis (PrEP) and antiretroviral-based microbicides help prevent new HIV infections through a regimen of daily pills, a monthly vaginal ring that slowly releases medication, or a medicated gel used before and after sex. But a concern with these prevention methods is that if a person becomes infected while using them, a strain of HIV could arise that resists drugs needed for treatment in the future. 

To begin the project, the Pitt-led team is analyzing laboratory data and previous research to create computer models and simulations. The models will help researchers balance the cost and inconvenience of testing with the risk of resistance. They will also enable researchers to provide optimal HIV testing recommendations. 

These findings will be presented to stakeholders in Africa, including community leaders, doctors, and health policy professionals who will be involved in implementing the prophylactic treatment effort.

In the third year, the team will provide final recommendations for HIV testing and then work with USAID and other groups, including the World Health Organization and the United Nations Programme on HIV/AIDS, to implement recommendations in regions where PrEP and microbicides are distributed.

Finally, the team will train local clinics in using low-cost tests to detect drug resistance so data can continue to be collected and guide future HIV prevention initiatives.

“Through this carefully crafted, step-by-step process, we’ll be able to provide critical data to develop cost-effective and appropriate HIV diagnostic and resistance testing and monitoring plans. As a result, we should be able to stay on top of any drug resistance that arises from antiretrovirals implemented for HIV prevention,” said John W. Mellors, chief of Pitt’s Division of Infectious Diseases and project director.

In addition to the involvement of Mellors and Parikh, Pitt’s April Churilla, senior research administrator in the Division of Infectious Diseases, is the project’s administrator.