£5m for HIV/AIDS trial involving HIV patients in London, Moscow, South Africa and Australia

A joint Oxford University/Imperial College research programme into HIV/AIDS has received £5 million support from the Wellcome Trust to carry out a drug trial involving HIV patients in London, Moscow, South Africa and Australia.

The trial, co-ordinated by Professor Jonathan Weber from Imperial with help from a MRC team led by Professor Abdel Babiker, will give combination anti-retroviral drugs to 400 patients with the earliest recognisable manifestation of HIV infection, a transient viral induced illness known as the 'acute retroviral syndrome'. The trial will test the idea that suppressing viral replication in the earliest phase of infection delays progression to AIDS. Researchers at the Peter Medawar Building for Pathogen Research in Oxford, led by Professor Rodney Phillips, who is joint Principle Investigator for the project, will analyse the results and use the opportunity to continue research into the clash which occurs when HIV first encounters the human immune response.

After HIV is contracted, the virus proliferates dramatically and spreads throughout the body before being partially repressed by the immune system. No-one ever gets rid of the virus once it is contracted. This early phase occurs a few weeks after the virus is caught and often brings the patient to medical attention, as the illness can resemble a bad attack of influenza.

'A hallmark of HIV is its erosion of the immune system, and in this early phase damage to the 'anti-HIV component' may be particularly severe, and certainly irreversible,' said Professor Phillips. 'After this stage the fully developed immune response holds the virus in check for around eight years. Although ostensibly under control, HIV continues to avidly undermine host immunity by invading the very cells that form the immune response.'

The researchers' hope is that by administering antiretroviral drugs during acute HIV infection, they will hasten suppression of the virus and lower its reproduction rate more than immune system by itself would. This 'dampening' of the virus for a limited period of 3 or 12 months (when the drugs will be stopped) might have an enduring benefit and so lengthen the time before AIDS develops. If the trial revealed this benefit the result would alter clinical practice throughout the world.

Professor Rodney Phillips said: 'After two years of recruitment to the clinical trial, we will analyse the results and follow up the patients for a further three years. We already know that antiretrovirals can very effectively prolong life in patients who would otherwise have died from AIDS. But now we wish to know whether potent drug combinations, used as a short course, can attenuate the irreversible destruction of the immune system which is set in train during this early episode of viral dissemination. If it proves useful to administer antiretrovirals at this short, key stage, we will have put off the day when patients will be obliged to take these drugs continuously to ward off AIDS. Although effective, these drugs have unpleasant side effects, so anything we can do to delay their chronic use would be a boon.

'The scientific evaluation of the trial patients' immunity and their viral dynamics will involve collaboration between scientists from the Departments of Clinical Medicine, Zoology and Statistics. The Peter Medawar Building and our colleagues in Zoology now constitute one of the most powerful groupings in the field of pathogen dynamics worldwide.'

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