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Monday December 6th

UNC leading AIDS research

	<p>Dr. Myron Cohen stands in front of a poster that hangs in his office building. Cohen led a study that has been hailed as strong evidence for the importance of early antiretroviral treatment in preventing the spread of <span class="caps">AIDS</span>.</p>
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Dr. Myron Cohen stands in front of a poster that hangs in his office building. Cohen led a study that has been hailed as strong evidence for the importance of early antiretroviral treatment in preventing the spread of AIDS.

Dr. Myron Cohen told Dr. David Margolis in 2005 that he wanted to create a center charged with curing AIDS.

Margolis, then an associate professor at the University of Texas Southwestern Medical School, was intrigued, and agreed to join the University faculty with that mission in mind.

Inside Cohen’s Study
  • 1,763 couples from nine different countries participated in the study.
  • The research was supposed to end in 2015, but the data and safety monitoring board decided the results were clear enough for immediate release.
  • The group required a quantity of drugs valued at more than $25 million.
  • Leaders of the study will continue monitoring participants for at least one more year.

More than five years later, a recently-released study led by Cohen — director of the UNC Institute for Global Health and Infectious Diseases — has been hailed as a landmark finding with heavy implications for slowing the global spread of AIDS.

Meanwhile, Margolis and two other UNC researchers might next week become beneficiaries of a federal investment of about $5 million per year aimed at eradicating the disease.

The developments are representative of the University’s prominence in the AIDS research community, as well as the transition of emphasis in the field from prevention to finding a cure for the virus.

“A year ago, somebody would have been embarrassed to say the word ‘cure’ in public,” Margolis said. “Now, things are different.”

Ninety-six percent success

Cohen’s study, made up of 1,763 heterosexual couples, has demonstrated the importance of early drug treatment to inhibit the transmission of HIV.

Of the 28 individuals who were infected by his or her partner in the course of the study, only one had received early antiretroviral treatment.

That constitutes a 96 percent success rate — a number that caught the attention of national and international news outlets as well as other researchers.

“I was pretty excited,” said Ronald Swanstrom, director of the UNC Center for AIDS Research.

“We’ve had a couple of trials that have been deemed successful with efficacy levels less than 50 percent,” he added.

Angela Kashuba, an associate professor in the Eshelman School of Pharmacy who is heavily involved in AIDS research, said the study’s success rate has not yet been seen in studies of its type.

“This is really a intervention that has demonstrated the greatest amount of efficacy in HIV prevention.”

But Cohen cautioned that the study’s results do not represent an unqualified endorsement of this strategy of prevention.

Practical implications of the study are limited for both richer and poorer countries, due to the makeup of the study’s subjects and the cost of antiretroviral drugs.

The study is made up of only heterosexual couples, a fact that suggests the study’s findings are more relevant to AIDS in Africa.

“Ninety-plus percent of cases (in Africa) are among heterosexual couples,” he said.

But the costs associated with programs of early antiretroviral treatment could pose problems for third-world countries as well.

“I’m certain it will be a struggle in trying to implement policy with the financial issues that are involved with the data,” Kashuba said.

Cohen said he will continue working to advance the field of AIDS prevention.

“Okay, it was 96 percent effective,” he said. “I need to understand why one patient got HIV. I need to get a drug combination that’s 100 percent effective.”

A shift to eradication

Next week, the National Institutes of Health will announce whether it will award more than $35 million over five years to a project whose leaders include two University faculty — Margolis and Victor Garcia-Martinez, a professor of medicine who was also recruited from the University of Texas Southwestern Medical School.

The project would conduct high-profile research surrounding AIDS eradication, a focus that represents a significant shift from the past emphasis on treatment.

“This would be the largest federal investment in eradication research ever — the largest single NIH investment in eradication research thus far,” Margolis said.

“We’re hopeful that it will be awarded,” he added.

Cohen sits on the panel that will decide whether to grant the money, he said.

The project — named the Martin Delaney Collaboratory — seeks to incorporate the work of researchers from the three different categories of AIDS research commonly referenced by those in the field: treatment, prevention and cure.

Margolis is currently working on research that seeks to eradicate AIDS by utilizing what some call the “shock and kill” strategy, he said.

In this method, the active virus is suppressed through antiretroviral medication, while drug therapy is used to effectively flush out the body’s reservoir of infection.

Combined with this view in the project is that of Garcia-Martinez, whose method of humanizing mice resides on the cutting edge of eradication research.

In this method, mice are biologically altered so they can be infected with the virus.

Eradication efforts can then be tested more quickly, and with greater freedom in the level of drug toxicity.

“We’ll probably cure a mouse in the next couple of years,” Margolis said.

If the project receives the NIH grant, it would be a testament to the prominence of the University’s research staff, said Kashuba, who added that Cohen played a large role in her decision to come to the University.

“This is a highly collaborative, highly multidisciplinary effort that is very unique to UNC,” she said.

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