1
|
Jarvis JN, Chou R, Harrison TS, Lawrence DS, Muthoga C, Mupeli K, Meya DB, Mwandumba HC, Kanyama C, Meintjes G, Leeme TB, Ndhlovu CE, Beattie P, Sued O, Casas CP, Makanga M, Ford N. Translating evidence into global impact: lessons for HIV research and policy development from the AMBITION trial. Lancet Glob Health 2023; 11:e1688-e1690. [PMID: 37858577 PMCID: PMC7615252 DOI: 10.1016/s2214-109x(23)00412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Joseph N Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OR, USA
| | - Thomas S Harrison
- Institute of Infection and Immunity, St George’s University London, London, UK
- MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - David S Lawrence
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Charles Muthoga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Kennedy Mupeli
- The Center for Youth of Hope (CEYOHO), Gaborone, Botswana
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry C Mwandumba
- Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Cecilia Kanyama
- Lilongwe Medical Relief Trust (UNC Project), Lilongwe, Malawi
| | - Graeme Meintjes
- The Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tshepo B Leeme
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chiratidzo E Ndhlovu
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Pauline Beattie
- European & Developing Countries Clinical Trials Partnership, Hague, Netherlands
| | - Omar Sued
- Pan American Health Organization, Washington, DC, USA
| | | | - Michael Makanga
- European & Developing Countries Clinical Trials Partnership, Hague, Netherlands
| | - Nathan Ford
- Department of Global HIV, Viral Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| |
Collapse
|
2
|
Young Holt B, van der Straten A, Barker T, Chirenje ZM, Cameron AI, Scott C, Casas CP, Romano J. Strategic actions to advance multipurpose prevention technologies in low- and middle-income countries. Front Reprod Health 2023; 5:1150857. [PMID: 37465533 PMCID: PMC10351869 DOI: 10.3389/frph.2023.1150857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 07/20/2023] Open
Abstract
Background HIV, other sexually transmitted infections (STIs) and unintended pregnancies are critical and interlinked health risks for millions of women of reproductive age worldwide. Multipurpose prevention technologies (MPTs) offer an innovative approach for expanding combined pregnancy and/or disease prevention. So far, MPT development efforts have focused mostly on HIV prevention, but about half of product candidates comprise compounds active against non-HIV STIs as well. This review aims to provide a framework that promotes the efficient advancement of the most promising preclinical products through the development pathway and into the hands of end-users, with a focus on women in low- and middle-income countries (L/MICs). Methods This mini review provides a summary of the current landscape of the MPT field. It comprises a landscape assessment of MPTs in development, complemented by a series of 28 in-depth, semi-structured key informant interviews (KIIs) with experts representing different L/MIC perspectives. Main results We identified six primary action strategies to advance MPTs for L/MICs, including identification of key research gaps and priorities. For each action strategy, progress to date and key recommendations are included. Conclusions To realize the life-saving potential of MPTs and maximize the momentum made to date, a strategic, collaborative and well-funded response to the gaps and next steps outlined in this paper is critical. A coordinated response can add rigor and efficiency to the development process, to successfully advance the most promising MPT products to the hands of end-users.
Collapse
Affiliation(s)
- Bethany Young Holt
- CAMI Health, Initiative for MPTs, Public Health Institute, Sacramento, CA, United States
| | - Ariane van der Straten
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, UCSF, San Francisco, CA, United States and ASTRA Consulting, Kensington, CA, United States
| | - Taryn Barker
- Children's Investment Fund Foundation, London, United Kingdom
| | - Z Mike Chirenje
- Department of Obstetrics and Gynecology, UCSF, San Francisco, CA, United States
| | | | | | | | | |
Collapse
|
3
|
Chandiwana NC, Serenata CM, Owen A, Rannard S, Pérez Casas C, Scott C, Hill A, Clayden P, Flexner C. Impact of long-acting therapies on the global HIV epidemic. AIDS 2021; 35:S137-S143. [PMID: 34848580 DOI: 10.1097/qad.0000000000003102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Long-acting antiretroviral drugs have emerged as exciting treatment and preexposure prophylaxis (PrEP) options for people with HIV and at risk of HIV. Long-acting regimens may improve dosing convenience, tolerability and cost compared with current daily-based oral therapy. They can also circumvent stigma associated with oral therapy for both treatment and PrEP, thereby improving adherence and outcomes. Yet, multiple challenges remain, many specific to low-income and middle-income countries (LMICs), where the epidemic is most concentrated and HIV prevention and treatment options are limited. To optimize the use of long-acting formulations, key outstanding questions must be addressed. Uncertain costing, scale-up manufacturing, complex delivery systems and implementation challenges are potential barriers when considering the scalability of long-acting ARVs for global use.
Collapse
Affiliation(s)
- Nomathemba C Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celicia M Serenata
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | | | | | - Andrew Hill
- Department of Translational Medicine, Liverpool University, Liverpool
| | | | - Charles Flexner
- Divisions of Clinical Pharmacology and Infectious Diseases, School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
4
|
Affiliation(s)
| | | | - Ian Grubb
- Health Hounds Inc, Toronto, ON, Canada
| | | |
Collapse
|
5
|
Casas CP, Hernández SM, Helena Solano M, Castiblanco RA, Carrillo AJ. Experiencias de mujeres frente al cuidado de hijos diagnosticados con hemofilia. iatreia 2018. [DOI: 10.17533/udea.iatreia.v31n2a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
Casas CP, Sossa CL, Linares A, Omaña-Orduz OP, Peña ÁM, Solano MH. Terapia secuencial: una opción en el paciente hemofílico que no responde al manejo con monoterapia con agentes puente, estudio observacional del GrHeCol (Grupo Hemofilia Colombia). iatreia 2018. [DOI: 10.17533/udea.iatreia.v31n2a01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
7
|
Hill A, Dauncey T, Levi J, Heath K, Pérez Casas C. Higher risks of mother-to-child HIV transmission in countries with lower HIV prevalence: UNAIDS 2013 results for 32 countries with generalised epidemics. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30927-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
8
|
Hill A, Dauncey T, Levi J, Heath K, Pérez Casas C. Higher risks of mother-to-child HIV transmission in countries with lower HIV prevalence: UNAIDS 2013 results for 32 countries with generalised epidemics. J Virus Erad 2015; 1:257-63. [PMID: 27482423 PMCID: PMC4946657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Diagnosis and treatment of HIV-infected mothers significantly lower rates of mother-to-child transmission (MTCT) of HIV. Early infant diagnosis (EID) is required to monitor success of prevention of MTCT (pMTCT) programmes. Our aim was to compare rates of MTCT, EID and pMTCT in countries with generalised epidemics. METHODS The UNAIDSinfo database includes country-level information on epidemic size, prevalence of HIV infection, EID rates and pMTCT coverage. The AIDS Spectrum model was used to estimate the number of children infected with HIV in 2013, for 32 countries with generalised epidemics. Least squares linear regression, weighted by epidemic size and controlling for GDP/capita, was used to correlate national adult HIV prevalence with estimated MTCT rates. RESULTS There were 32 countries with generalised epidemics included in the analysis (31 in Africa). Higher-prevalence countries (≥5%) had significantly lower rates of MTCT (P<0.01) than lower-prevalence countries (<5%). For 20 lower-prevalence countries (total 7.4 million HIV-infected people), there were 105,300 childhood (0-14 years) infections in 2013. In 12 higher-prevalence countries (total 17.1 million HIV-infected people), there were an estimated 107,500 childhood infections in 2013. Regression analysis suggests that if all countries achieved the same MTCT rate as Botswana (2.0%), childhood HIV infections could be cut by 88% (from 105,300 to 12,300 per year) in lower-prevalence countries, and by 82% (from 107,500 to 19,700 per year) in higher-prevalence countries. CONCLUSIONS In this analysis of 32 countries with generalised HIV epidemics, 49.5% (105,500/213,000) of childhood HIV infections in 2013 were in lower-prevalence countries. Targeting of prevention of MTCT in lower-prevalence countries needs to be prioritised, despite challenges, to reduce the number of children infected.
Collapse
Affiliation(s)
- Andrew Hill
- St Stephen's AIDS Trust,
Chelsea and Westminster Hospital,
London,
UK,Corresponding author: Andrew Hill, St Stephen's AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Thomas Dauncey
- School of Public Health, Faculty of Medicine,
Imperial College London,
UK
| | - Jake Levi
- School of Public Health, Faculty of Medicine,
Imperial College London,
UK
| | - Katherine Heath
- School of Public Health, Faculty of Medicine,
Imperial College London,
UK
| | | |
Collapse
|
9
|
Abstract
Tido von Schoen-Angerer and colleagues discuss the new Affordable Medicines Facility for malaria (AMFm), which subsidizes and facilitates access to artemisinin-based combination therapy, and what mechanisms are needed to ensure it stays focused on quality patient care.
Collapse
Affiliation(s)
- Suerie Moon
- Giorgio Ruffolo Doctoral Research Fellow, Sustainability Science Program, Center for International Development, Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
| | - Carmen Pérez Casas
- Campaign for Access to Essential Medicines, Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | |
Collapse
|
10
|
Oliveira-Freitas E, Casas CP, Borja-Cabrera GP, Santos FN, Nico D, Souza LOP, Tinoco LW, da Silva BP, Palatnik M, Parente JP, Palatnik-de-Sousa CB. Acylated and deacylated saponins of Quillaja saponaria mixture as adjuvants for the FML-vaccine against visceral leishmaniasis. Vaccine 2006; 24:3909-20. [PMID: 16556475 DOI: 10.1016/j.vaccine.2006.02.034] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 02/13/2006] [Indexed: 11/20/2022]
Abstract
The adjuvant of the FML-vaccine against murine and canine visceral leishmaniasis, the Riedel de Haen saponin mixture, was fractionated by ion exchange chromatography on DEAE-cellulose to afford one TLC homogeneous Quillaja saponaria Molina QS21 saponin fraction (18.0%), a mixture of two deacylsaponins (19.4%), sucrose (39.9%), sucrose and glucose (19.7%), rutin (0.8%) and quercetin (2.2%), that were identified by comparison of 1H and 13C NMR spectroscopy. The QS21 shows the typical aldehyde group in C-23 (65% equatorial) and a normonoterpene moiety acylated in C-28. The deacylsaponins show the aldehyde group but do not have the normonoterpene moiety. Balb/c mice were vaccinated with 150 microg of FML antigen of Leishmania donovani and 100 microg of each obtained fraction and further challenged by infection with 10(8) amastigotes of Leishmania chagasi. The safety analysis and the effect on humoral and cellular immune responses and in clinical signs showed that the QS21 saponin and the deacylsaponins are the most active adjuvant compounds of the Riedel the Haen saponin mixture. Both induced the highest and non-significantly different increases in DTH, CD4+ T lymphocytes in spleen, IFN-gamma in vitro, body weight gain and the most pronounced reduction of parasite burden in liver (95% for QS21 and 86% for deacylsaponins; p>0.05). While the QS21 showed mild toxicity, significant adjuvant effect on the anti-FML humoral response before and after infection, and decrease in liver relative weight, the deacylsaponins showed no toxicity, less haemolysis and antibody and DTH responses increased mainly after infection, still inducing a stronger Leishmania-specific in vitro splenocyte proliferation. Our results confirm in the Riedel de Haen saponin extract the presence of deacylsaponins normonoterpene-deprivated which are non-toxic and capable of inducing a specific and strong immunoprotective response in vaccination against murine visceral leishmaniasis.
Collapse
MESH Headings
- Acylation
- Adjuvants, Immunologic/administration & dosage
- Animals
- Antibodies, Protozoan/blood
- Antigens, Protozoan/administration & dosage
- Antigens, Protozoan/immunology
- CD4-Positive T-Lymphocytes/immunology
- Chromatography, Ion Exchange
- Disease Models, Animal
- Enzyme-Linked Immunosorbent Assay
- Female
- Hemolysis
- Hypersensitivity, Delayed
- Interferon-gamma/biosynthesis
- Lectins/administration & dosage
- Lectins/immunology
- Leishmania donovani/immunology
- Leishmaniasis, Visceral/immunology
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Leishmaniasis, Visceral/prevention & control
- Liver/parasitology
- Liver/pathology
- Magnetic Resonance Spectroscopy
- Mice
- Mice, Inbred BALB C
- Molecular Structure
- Plant Extracts/chemistry
- Plant Extracts/immunology
- Protozoan Vaccines/immunology
- Quillaja/chemistry
- Saponins/administration & dosage
- Saponins/chemistry
- Saponins/immunology
- Saponins/toxicity
- Spleen/immunology
Collapse
Affiliation(s)
- E Oliveira-Freitas
- Instituto de Microbiologia Prof. Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, P.O. Box 68040, CEP 21941-590 Rio de Janeiro, Brasil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Palatnik de Sousa CB, Santos WR, Casas CP, Paraguai de Souza E, Tinoco LW, da Silva BP, Palatnik M, Parente JP. Protective vaccination against murine visceral leishmaniasis using aldehyde-containing Quillaja saponaria sapogenins. Vaccine 2004; 22:2470-9. [PMID: 15193411 DOI: 10.1016/j.vaccine.2004.01.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2003] [Accepted: 01/06/2004] [Indexed: 10/26/2022]
Abstract
The presence of aldehyde groups at C-23 and C-24 of the triterpen aglycon moiety was disclosed in 1H NMR spectra of both the Riedel de Haen saponin (R) (delta 9.336) and Quillaja saponaria QuilA saponin (delta 9.348). The sign of the C-28 acylated linked moiety (delta 176) was present in both saponins, while the delta 171 at C-28 (carboxy group) corresponding to the deacylated saponin, was only detected in the QuilA preparation, indicating 50% of hydrolysis of the ester moiety, probably due to the storage in aqueous solution. The normoterpen moiety was present in both saponins (signals at delta 14-18). The chemical removal of saponin glicidic moieties gave rise to their sapogenin fractions. Their 1H NMR spectra showed the presence of two signals (delta 9.226 and 9.236) for sapogenin R and two signals (delta 9.338 and 9.352) for the QuilA sapogenin. The intensity of the signals suggested two conformational isomers of sapogenin R in the ratio 53% of equatorial aldehyde group to 47% of axial aldehyde group, and two conformational isomers of QuilA sapogenin in the ratio 76% of equatorial aldehyde group to 24% of axial aldehyde group. The chemical treatment abolished the saponin slight in vivo toxicity, reduced their hemolytic potential, did not affect their aldehyde contents, but gave rise to an enriched axial aldehyde-containing sapogenin R with enhanced potential on antibody humoral response (anti-IgM, IgG, IgG1, IgG2a, IgG2b and IgG3) and to an enriched equatorial aldehyde-containing QuilA-sapogenin that induced a mainly cellular specific immune response (increased intradermal response to leishmanial antigen and IFNgamma sera levels) and effective protection against murine infection by L. donovani (77% reduction in liver parasitic load). Our results suggest that the Riedel de Haen saponin is probably a Quillaja saponaria saponin.
Collapse
Affiliation(s)
- C B Palatnik de Sousa
- Instituto de Microbiologia, Prof. Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), CCS, Cidade Universitária, Ilha do Fundão, CP 68040, CEP 21941-590, Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|