Duke Awarded $4 Million in First NIH Grant for AIDS Co-Infection Study
DURHAM, N.C. -- Researchers at Duke University Medical Center have received a $4 million, four-year grant from the National Institutes of Health to study infectious diseases that plague AIDS patients in Tanzania.
The grant is the first and only award bestowed this year through the International Studies of AIDS-Associated Co-Infections (ISAAC) program, initiated in 2003 by the National Institute of Allergy and Infectious Diseases, a division of the NIH. The amount is among the largest awards ever given for study of AIDS co-infections in resource-challenged tropical countries such as Tanzania, said principal investigator John Bartlett, M.D., professor of medicine in the division of infectious diseases at Duke University Medical Center. "This grant moves Duke to the forefront of working in international health," he said.
The region of northeast Tanzania where the study will take place has a population of about 10 million. About 10 percent are living with HIV/AIDS.
At least 60 percent of the grant must be spent in Tanzania, the majority of which will support creation of a medical research infrastructure. "This is a really crucial part of our mission," Bartlett said. The investment in equipment, laboratory space and training will enable scientists in Tanzania to develop an independent research program that will continue after the grant ends.
Duke researchers will also use the grant to develop low-cost, low-tech methods to detect and diagnose diseases such as tuberculosis, meningitis and cervical cancer (caused by a virus). The majority of laboratory tests on which doctors in the U.S. rely to diagnose infectious disease are unavailable in Tanzania because of cost and lack of equipment. "The limited laboratory capacity means the source of disease often can't be identified," said John Crump, M.D., a Duke professor of medicine who works full-time at the Kilimanjaro Christian Medical Centre in Tanzania
An important focus of the four-year study is answering such basic questions as: what are the most common infectious diseases in people with HIV/AIDS; how often do infectious diseases occur in the HIV/AIDS population, and how do infectious diseases affect the severity and morbidity of AIDS.
Led by Duke assistant professor of medicine, Nathan Thielman, M.D., the epidemiology and biostatistics study team will establish the baseline rates of disease progression -- including determining whether HIV progresses more rapidly in tropical settings -- and define the incidence, clinical presentations and outcomes of key co-infections.
Many of the common co-infections in Tanzania -- tuberculosis, malaria, meningitis -- take the lives of HIV/AIDS patients before AIDS runs its course. "Most HIV-infected children in developing countries die of tuberculosis, diarrheal disease, malnutrition or malaria before developing full-blown AIDS," said Coleen Cunningham, M.D., professor of pediatrics and chief of pediatric infectious diseases at Duke. Cunningham will lead a pediatric research team in devising treatments to prevent these diseases in children and identify those at risk before they develop co-infections.
There is evidence that co-infections, especially malaria, may raise blood levels of HIV and diminish the immune response to HIV, said the researchers. The HIV and co-pathogens interactions study team will examine the interactions between HIV and co-infections such as TB and malaria in the absence and presence of antiretroviral therapy drugs. A separate study team led by Chris Drakeley of the London School of Hygiene and Tropical Medicine will compare malaria infection rates in cooler, high-altitude regions of Tanzania -- which have fewer mosquitoes -- with rates in lower elevations to determine whether HIV infection predisposes people to severe, fatal malaria.
The women's health study team will educate women in Tanzania about cervical cancer and train health care providers to screen and test for the disease in a single visit. Cervical cancer is the leading cause of cancer death among women in developing countries and is preventable, said David Walmer, M.D., professor of obstetrics and gynecology and chief of reproductive endocrinology. Walmer and Duke colleagues successfully developed a similar program in Haiti and invented a quick screening test that could be performed with available technology, including a halogen bicycle lamp.
In addition to study teams already mentioned, the grant funds research in mycology, including fungal infections that cause meningitis; mycobacteriology, focusing on tuberculosis; bacteriology and non-malaria parasites. Meningitis has a 100 percent mortality rate in neighboring Zambia, and about 50 percent of the population in sub-Saharan Africa is latently infected with TB.
Duke researchers have nearly 20 years experience working in Africa and receive $20 million annually for HIV/AIDS research. Duke's partners in Tanzania include the Kilimanjaro Christian Medical Centre, the Kibongoto National Tuberculosis Hospital and KIWAKKUKI, a community-based organization that provides home care.
"The relationship that has developed between our faculty and the doctors and nurses from these centers is a model for the way major academic institutions should think about global health," said Pascal Goldschmidt, M.D., chair of the department of medicine at Duke. "It is a remarkably important effort in regard to helping care providers fighting the AIDS epidemic, as well as defining what are the emerging epidemics across the world and how we can protect our patients here at home."