Breakthrough in HIV-Aids therapy after Covid input
The global drive to manufacture Human Immuno Deficiency Virus (HIV) vaccines in large quantities has gained momentum but challenges frustrating this important initiative still abound.
However, the zeal to use mRNA technology adopted by medical researchers to make HIV vaccine continues despite protracted challenges in the development process. The development comes amid warnings that the achievement could be more than five years away in the making.
A UNAids 2021 report shows that adults and children living with HIV/Aids in Kenya stood at 1.4 million, out of whom women aged 15 and above were about 890,000, while men (15 years and above) were 470, 000. The HIV prevalence rate among adults (15-49 years) was 4 per cent, women (15-49) was 5.4 per cent, men in the same age bracket stood at 2.6 per cent while young women catered for 2.1 per cent.
HIV and Aids attack the immune system and usually manifest many years later.
Kisumu study
In 2020, the National Aids and STIs Control Programme revealed in a study spearheaded by JhPiego that Kisumu County had 4,661 new HIV cases, with youth aged 15-24 accounting for most of them.
Subsequently, the county initiated public health interventions such as use of condoms and abstinence from sex, while those already infected were put on antiretroviral therapy to manage the disease.
Neighbouring counties like Kisii and Migori had earlier rolled out the Pre-Exposure Prophylaxis (PrEP) in collaboration with JhPiego, through the Jilinde Research Programme, to widen protection from HIV.
It is in this light that Linda-Gail Bekker, the executive director of Desmond Tutu Health Foundation, termed the use of HIV Antiretroviral Lenacapavir as a potential game-changer. She was referring to application of mRNA technology to accelerate HIV shot (vaccine) development.
Bekker said there were already five trials with HIV vaccines in the field, adopting the mRNA platform, but they were still in the early stages of human testing and would most likely take 3-4 years to reach the final stage of trials.
On the decades-long hunt for a shot to safeguard against HIV, Bekker said late-stage trials in human subjects, if successful, were a precursor to applications for licences to sell the vaccines commercially.
She explained that mRNA technology is also being used to make vaccines against Covid-19 — such as Moderna, Pfizer and BioNTech SE, which temporarily turn cells into tiny vaccine-making factories.
Weakened pathogen
However, she noted, previous generations of vaccines have primed the immune system with an inactivated or weakened version of a pathogen, or its piece.
“The great thing about the mRNA platform is that you can tweak it quickly,” said Bekker, a former president of the International Aids Society, during an interview in Cape Town, South Africa, recently.
Bekker observed that unlike HIV vaccines, the Covid-19 ones were produced within a year owing to huge funding from development partners and research expertise. She added that private, public and the academia all came together to combat the Covid-19 scourge.
But what does this situation portend for Africa, and more specifically Kisumu? Firstly, Africa has the world’s largest number of people infected with HIV, with about 13 per cent of 1 billion being virus carriers.
Medical experts from WHO explain that HIV targets cells in the immune system, which are the body’s defence against illness, weakening the body’s ability to fight infections and some types of cancer.
The virus destroys white blood cells in the immune system called CD4 cells, replicating itself inside these cells. Subsequently, it destroys and impairs the function of these cells. The person gradually becomes immunodeficient, unable to fight infections and disease, hence vulnerable to opportunistic infections and cancers. Immunity is typically measured by CD4 cell count.
Bekker lamented that the health sector has never received the same kind of attention to HIV and Tuberculosis (TB), which mainly affect the poor, as it did for Covid-19. This illustrates the need for Africa to tap the technology needed to develop its own vaccines and treatments.
In South Africa, the Desmond Tutu Foundation is engaging in a proactive attempt to find solutions by carrying out trials of several vaccines. Dubbed “Sherpa trial”, it seeks to evaluate the extent healthcare workers who have received two Johnson & Johnson Covid-19 vaccination could benefit from a Moderna shot.
Notably, the other attempt called the “Ubuntu trial”, which stretches across several African nations, was designed to determine the Moderna vaccine’s efficacy in people infected with HIV.
The foundation has also begun enrolling participants in a trial called “Lenacapavir”, an anti-retroviral that is used to prevent HIV infection and is administered via injection every six months. Lenacapavir’s development follows Cabotegravir, another preventative drug to be administered every two months.
