The PIONA project is an example of Q-research’s commitment to the West African country Guinea-Bissau, where several of our employees have worked and researched.
The purpose of the PIONA project is to compare two different HIV treatments among the patients in the Bissau HIV cohort. Our hypothesis is that the treatment recommended by WHO as the standard treatment, is not the most effective in HIV infected people in Guinea-Bissau.
WHO’s recommended standard treatment is based on a drug called NNRTI (non-nucleoid revers transcriptase inhibitor). This treatment is very effective in knocking down the virus, but it has some limitations in the challenges that HIV infected people in Guinea-Bissau faces.
The treatment consists of 3 types of drugs that should preferably be taken at the same time each day. If the treatment is interrupted, two of the drugs will quickly disappear from the blood, which makes the treatment consist of only one drug. This makes the viral load rise with the risk that the HIV infected will become resistant to the drug.
In general, resistance to HIV treatment is a growing problem in Guinea Bissau and other West African countries, because many HIV infected do not take their medication regularly. Vast distances and poor infrastructure means, that HIV-infected can have difficulty regularly receiving their medication at the HIV clinics, which also sometimes run out of medicine. In addition, a general lack of knowledge about the disease among the infected makes it difficult for them to understand the necessity of taking their medication every day, if they feel healthy.
Hypothesis: Our hypothesis is that by changing the standard treatment we will experience less resistance to the medication, which is one of the biggest challenges in the spread of HIV in Africa.
WHO’s second choice of HIV treatment is called a PI based treatment (protease inhibitor). Compared to the standard treatment, it must me taken twice a day and can cause side effects as nausea and stomachache. On the other hand, it is a more robust treatment, and it is more difficult to develop resistance to the drug.
The choice of standard treatment is based on clinical trials in the western countries, but our theory is that the second treatment is better suited for HIV in West Africa.
HIV-1 and HIV-2
Another argument that speaks for using the PI-based treatment in West Africa is the large group of patients with HIV-2. HIV-2 is a subtype of HIV that is only spread in West Africa and is resistant to WHO’s standard treatment against HIV.
Yet it often happens that people infected with HIV-2 are treated with the ineffective standard treatment against HIV-1 in West Africa. Therefore, we believe that PI based treatment will have a better effect as a standard treatment in West Africa, although it must be taken twice a day, since it works against both HIV-1 and HIV-2.
The Piona project has now as planned included 400 HIV infected people, who have been followed for a year. We await transport of blood samples to Denmark for further analysis of the effects of the treatment, and we expect to announce the first results during 2015.
The following articles have been made as a part of the work with the Bissau HIV cohort:
Cohort Profile: The Bissau HIV Cohort - a cohort of HIV-1, HIV-2 and co-infected patients.
International Journal of Epidemiology, Oktober 2014
Challenges facing HIV treatment in Guinea-Bissau: the benefits of international research collaborations
Bulletin of the WHO, September 2014
Performance of 3 rapid tests for discrimination between HIV-1 and HIV-2 in Guinea-Bissau, West Africa
Journal of Acquired Immune Deficiency Syndroms, Januar 2014
Inter-observer variation of the rapid test SD Bioline HIV 1/2 3.0 for HIV type discrimination: experiences from Guinea-Bissau.
Journal of Acquired Immune Deficiency Syndroms, December 2014
Hepatitis C prevalence among HIV-infected patients in Guinea-Bissau: a descriptive cross-sectional study.
International Journal of Infectious Diseases, November 2014
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