Wits RHI researchers take HIV ART to the next level

by | Jul 31, 2019

Wits researchers presented a study in Mexico City with results that could save millions of lives.

Researchers from Wits Reproductive Health and HIV Institute (RHI) are conducting a study that could change how South Africans take antiretroviral treatments (ARTs).

Professor Francois Venter from Ezintsha, a subdivision of Wits RHI, presented the latest results of the study, named ADVANCE, at the 10th International AIDS Society Conference on HIV Science in Mexico City from 21-24 July.

The ongoing study has so far been conducted for 48 weeks in Johannesburg and is due to end in mid-2020.

Published in the influential New England Journal of Medicine (NEJM), the study focused on changing two elements of the standard three-combination drug treatment used to successfully suppress HIV.

ADVANCE included two new replacement drugs called tenofovir alafenamide (TAF) and dolutegravir (DTG) in the treatment of at least 1050 HIV-positive participants in the Johannesburg suburbs of Hillbrow and Yeoville, who had never taken ARVs.

At 48 weeks of a 96-week course, the study found that DTG provided the benefits of its predecessor, the drug efavirenz (EFV), but with fewer negative side effects on organs such as bones, liver or kidneys.

Dr Michelle Moorhouse, who is one of the co-principle investigators of ADVANCE and head of treatment strategies at Wits RHI, told Wits Vuvuzela the study could limit the barriers faced by people living with HIV who were seeking treatment.

“DTG has few side effects and is very robust, which means the virus does not easily become resistant to DTG, as it does to EFV.

“It is a low dose, which means a smaller pill, and when rolled out to millions of people there will be significant cost savings, allowing more people to access ART,” said Moorhouse.

ADVANCE is a potential game changer for South African ART guidelines and provides evidence for why the country should change to DTG.

Another co-principle investigator of ADVANCE, Nkuli Mashabane, said, “One of the takeaways should be that Wits researchers have the capability to conduct policy impacting clinical research that not only has global impact but improves the lives of South Africans affected by HIV.”

For Wits University, the study emphasises the institution’s dedication to scientific research that consistently makes its way across the world.

“I think we should be very proud that a group of researchers from Wits designed and conducted a world-class study that has informed global as well as national guidelines and in so doing has provided data to answer some questions about DTG and TAF,” said Moorhouse.

The university currently does not offer ARVs on campus, but the head of Campus Health and Wellness, Sister Maggie Moloi, is in discussions with the Department of Health to make ARVs accessible to students.

“We cannot buy ARVs. They are very expensive. It’s better if we get them through the department of health,” said Moloi. “The staff here are going to be trained by the Department of Health about the new medication; it’s better working with them.”

The main advantage of DTG is that it is cheaper to produce and could bring South Africa one step closer to its 90-90-90 targets: 90% HIV-positive people knowing their status, 90% of those being on ART, and 90% of ART users having an undetectable viral load. That shows the HIV count is low and tests cannot recognise the virus in the blood.

“Smaller pills and few side effects make ART easier to take and easier to adhere to, which benefits the second 90,” said Moorhouse.

“Because DTG is so robust, and it is hard for the virus to develop resistance again, it is very important for the third 90. Hopefully the newer regimens will encourage more people to come forward for testing and diagnosis, helping with the first 90 and a knock-on effect on the second and third.”

The DTG-containing regimens will be available for public use in September.

FEATURED IMAGE: A new DTG-containing ART is coming to South Africa. Photo: Karen Mwendera.

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