Image by Garth Dyer, Architectural Graphic for FGG Architects ©2009

Artist's rendition of the KwaZulu-Natal Research Institute for TB and HIV in Durban, South Africa.

The Howard Hughes Medical Institute (HHMI) and the University of KwaZulu-Natal are working to change this.

In March the two organizations established the KwaZulu-Natal Research Institute for TB and HIV (K-RITH) on the campus of the Nelson R. Mandela School of Medicine in Durban, South Africa. Construction will begin in the fall.

HHMI is providing $20 million towards construction of the 6 story building which will include two floors of biosafety level 3 labs - facilities specially equipped to study dangerous biological agents such as bacteria that cause tuberculosis. The University of KwaZulu-Natal and the South African government are also providing support.

The new institute has two goals: to make major scientific contributions towards controlling TB and HIV, and to train a new generation of scientists in Africa.

“The problem is that one group of people were studying HIV by itself and another group was studying TB by itself,” said HHMI vice president Peter Bruns in an interview with the Chronicle of Higher Education. “We know a lot about each of them separately, but not together - and they do change each other when they happen together.”

South Africa had nearly half a million new cases of TB in 2006 and is home to TB bacteria that are resistant to many of the antibiotics normally used for treatment (the so-called multidrug and extensively drug-resistant strains). South Africa has more residents infected with HIV than any other country on Earth. 44 percent of new TB patients test positive for HIV.

“The projects defined in the K-RITH program are there to address important research questions that would provide greater insights, understanding and the potential for solutions. All these should bring hope to people who are infected and affected,” Malegapuru William Makgoba, UKZN’s vice chancellor, said at a press conference announcing the new institute. “Most critically, this partnership is an investment into the future, in the training of a new generation of scientific leaders in this important area of health research.”

As Secretary of State Hillary Clinton visits Africa August 4-14, Science Planet will highlight African scientists and science in Africa.

Are there too few professors in Africa? Or is lack of laboratory facilities a bigger problem? Do most young African scientists choose to make their careers outside of Africa? Are there really “vanishingly few” opportunities for foreign-trained African researchers to return to do research in their home countries? What can be done to encourage African scientists to remain in Africa? Is it fair to discuss the entire African continent as if it were one nation?

In honor of World AIDS Day on December 1, we’re examining the results of a clinical trial suggesting a way to prevent illness and death in babies infected with HIV.

The World Health Organization (WHO) established World AIDS Day to give governments, national AIDS programs, faith organizations, community organizations and individuals a chance to raise awareness and focus attention on the global AIDS epidemic. (See Global Health Specialist Will Talk About World AIDS Day)

Infants infected with HIV type 1 are more likely to die than older children. Treating kids with a cocktail of antiretroviral medications can be effective initially, but long-term administration of antiretrovirals is problematic because the virus often evolves resistance and antiretroviral medications can be toxic.

Should HIV-positive infants begin treatment before clinical symptoms develop, or are the current guidelines of waiting until symptoms develop more effective?

The Children with HIV Early Antiretroviral Therapy (CHER) trial tried to answer this question. At two hospitals in South Africa (Chris Hani Baragwanath Hospital, Soweto and Tygerberg Children’s Hospital, Cape Town) physicians randomly assigned 6- to 12-week-old infants who had HIV infections but no clinical symptoms into three groups.

One group began antiretroviral therapy immediately for 40 weeks, a second group for 96 weeks, and a third group began treatment only after they displayed a clinical symptom of infection (low number of CD4-positive T cells, HIV-associated lung disease and pneumonia, kidney or heart problems, oral thrush, failure to thrive).

Antiretroviral therapy beginning at, on average, seven weeks after birth reduced mortality to 4 percent (10 babies died out of a total of 252), compared with 16 percent in babies that began treatment only after displaying symptoms (20 of 125). Disease progressed to more advanced stages in only 6 percent of infants who received early treatment (16 of 252), compared with 26 percent in the deferred therapy group (32 of 125).

Early antiretroviral treatment reduced infant mortality by 76 percent and HIV progression by 75 percent.

Immediate treatment is so effective that the CHER trial led to a new standard of care – instead of postponing treatment until signs of illness or a weakened immune system appear, WHO now “strongly” recommends starting antiretrovirals in children under age 1 immediately after HIV diagnosis, regardless of their state of health.

To learn more about the story of HIV/AIDS, check out:
http://www.hhmi.org/biointeractive/disease/lectures.html

The Howard Hughes Medical Institute (HHMI) presents four 60-minute presentations examining the story of HIV/AIDS:

• From Outbreak to Epidemic by infectious disease specialist Dr. Bisola Ojikutu
• AIDS and the HIV Life Cycle by HHMI investigator Dr. Bruce Walker
• Drugs and HIV Evolution, by Dr. Ojikutu
• Vaccines and HIV Evolution, by Dr. Walker

“Early antiretroviral therapy and mortality among HIV-infected infants” by Avy Violari, Mark F. Cotton, Diana M. Gibb, Abdel G. Babiker, Jan Steyn, Shabir A. Madhi, Patrick Jean-Philippe, James A. McIntyre, and the CHER study team appears in the November 20, 2008, New England Journal of Medicine.

CHER was supported by the National Institutes of Health; the departments of Health of the Western Cape and Gauteng, South Africa; and GlaxoSmithKline.