September 18, 2013
Vancouver, BC – In 1988, Walter Hiebert was given what amounted to a death sentence: he was diagnosed with HIV and given just six months to live. “I didn’t have any hope at all,” says 56 year-old Hiebert, who had to go on disability from his job as a registered nurse.
Twenty-five years later, he’s alive and thriving, thanks to the pioneering efforts of world-renowned Vancouver-based HIV/AIDS researchers. “The HIV drug ‘cocktail’—the magical combination of three anti-retroviral drugs—saved my life,” says Hiebert who supports the goals of this new $5 million HIV/AIDS research project. Funded by Genome BC, this project aims to develop an improved HIV drug-resistance test, real-time drug resistance surveillance and better methods for personalizing treatment of HIV based on each patient’s unique DNA.
“The new resistance test will make the therapy more effective in reducing the amount of HIV in the blood, which benefits patients, and lessen the chances of spreading the virus,” says Dr. Richard Harrigan, project leader, Director of the Laboratory Program and head of genomics research at the BC Centre of Excellence in HIV/AIDS (BC-CfE) at St. Paul’s Hospital in Vancouver. Based on the latest DNA sequencing technology, this cutting-edge test will detect drug-resistant HIV strains that existing ones can’t. “This test will be a better, more sensitive tool that takes less time to get results and is less expensive,” explains Harrigan, whose past work has been instrumental in the development of viral resistance testing in Canada and internationally.
The researchers will develop new personalized tests, based on a patient’s DNA, to guide therapy as well and avoid serious side effects. The two types of tests—viral and human genomic—will help doctors prescribe the best drug cocktail for each patient, one that works well and minimizes side effects that may cause patients to stop treatment. “We plan to expand the number of human genomic markers tested so we can predict side effects for all classes of HIV drugs. Side effects drive whether or not patients take these drugs and stick with them,” says Harrigan.
The research team is also creating a new early warning system to monitor and map drug resistance. It will pinpoint geographic or population “hotspots” where resistance rates are highest and the risk of transmission greatest. “We’ll be able to monitor the emergence of drug resistance in real time and identify patients with newly acquired drug-resistant strains faster. We can then intervene proactively and preemptively so the resistance doesn’t become widespread,” says Dr. Julio Montaner, co-leader of the project, Director of the BC-CfE and the Director of AIDS Research and Head of the Division of AIDS in the UBC Faculty of Medicine.
Results of the research project will give patients like Hiebert—whose drug cocktail had to be changed after he developed resistance—an even better chance of staying healthy. “The new resistance test will be great for newly diagnosed people and experienced people who have been HIV-positive for a long time,” he says.
All HIV patients in Canada through their doctors will have access to the new test at the BC-CfE labs. The technology will be shared with labs globally, so it can be adopted worldwide.
“Genome BC is funding an important example of personalized medicine that is making a difference in the lives of HIV patients,” says Dr. Alan Winter, President and CEO of Genome BC. “We’re very proud to be partnering with Dr. Harrigan and Dr. Montaner, whose work has changed the prognosis for millions of people around the globe.”
Additional funders for this project include Genome Canada, Genome Quebec, the Canadian Institutes of Health Research, ViiV Healthcare and the St. Paul’s Hospital Foundation.
BACKGROUND:
- HIV infection is one of the top five causes of disability adjusted life years (DALYs) lost in 47 countries worldwide and is the number one health burden in 12 countries.
- Over 35 million people worldwide are infected with HIV and 70,000 in Canada. Nearly $1 billion is spent on HIV drug cocktail therapies in Canada each year. Annual drug savings from the new resistance test alone will amount to $15,000 per year for each case of HIV avoided.
- Preventing 50 new HIV infections each year over five years would produce direct drug savings of $11.25 million—and that doesn’t include other medical costs for HIV patients, or lost productivity in Canada.
- Nearly all HIV infected individuals require treatment within 10 years of infection. Modern HIV treatment typically consists of a “cocktail” of three antiretroviral drugs (called HAART – highly active antiretroviral therapy). This approach aims to reduce the amount of virus in the bloodstream, as well as to reduce the likelihood of developing resistance to these drugs.
- HIV treatment has evolved dramatically since HAART was first introduced at the Vancouver International AIDS Conference in 1996. It has transformed HIV infection into a more manageable, chronic condition and directly saved millions of lives. There are also further indirect benefits of HAART – successful viral suppression can prevent transmission of HIV to others2.
- The research project consists of a series of activities which will produce the three deliverables to optimize HIV therapy, improve HIV suppression and reduce HIV drug resistance. Several unique aspects of the research team are particularly advantageous:
- they currently provide all of Canada’s clinical HIV genome-based drug resistance testing with a proven history of clinical utility, general acceptance and reimbursement;
- they have experience developing and validating “next-generation” methods and implementing these in the clinic;
- they have access to the required clinical samples with appropriate consent and matching longitudinal data to allow appropriate validation of new tests both from randomized Phase III clinical trials and from province-wide registries;
- project leaders are recognized as global leaders in HIV therapy and resistance
- they have very close links to users, guideline committees and policy makers to make implementation and reimbursement decisions.
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About the BC Centre for Excellence in HIV/AIDS:
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians living with HIV.
