[Spotlight originally posted January, 2011]
“Research must include investigation into opportunist infections such as TB, as HIV cannot be looked at in isolation.” –Dr. Prudence Ive, Wits HIV Research Group ACTG Clinical Research Site Principal Investigator, and CMC member of the ACTG A5221, Johannesburg, South Africa.
Tuberculosis (TB) and the emerging multi-drug resistant (MDR) TB epidemic represent a major challenge to human immunodeficiency virus (HIV) care and treatment programmes, particularly in resource-limited environments. TB in South Africa has always been a problem historically and there is an exponential rise in TB due to HIV.
TB is a major cause of mortality among patients with HIV and represents risk throughout the course of HIV disease, even after successful initiation of antiretroviral treatment (ART). Progress in the implementation of activities directed at reducing TB burden in the HIV population still lags behind global targets.
HIV programmes designed for long-term care are ideally suited to implement TB control measures and must address TB rigorously to save patient lives and safeguard investment in HIV the treatment programme.
Dr. Ive is the site-PI and member of the clinical management committee of the recently completed A5221 study. She explains that trials have had to branch out into opportunist infections like TB, malaria and cervical carcinoma and HIV cannot be looked at in isolation. The study, which began in 2007 and was completed in August 2010, specifically evaluates whether following the starting of TB treatment, ART should also be started immediately (within two weeks) or deferred by 8-12 weeks. Study participants must have CD4 counts of less than 200 cells per mm3. The study has been evaluated and results will be presented at the upcoming Conference for Retroviruses and Opportunistic Infections in Boston (CROI Feb 2011).
“Our observational studies from the Themba Lethu Clinic at Helen Joseph Hospital, have found that once patients are on ARTs, the instances of TB go down dramatically,” comments Dr. Ive. “Patients stable on ARTs are less likely to contract TB however we are still finding it difficult to treat patients that have contracted MDR TB, many of whom appear to come from the same source in KwaZulu Natal.”
About the Wits HIV Research Group ACTG Site
The Wits HIV Research Group ACTG site, based at the Helen Josef Hospital in Johannesburg, South Africa, is one of multiple sites worldwide conducting the ACTG international studies. The site has been active in the ACTG since 2002, under the Clinical Trials Unit (PI – Ian Sanne). Dr. Prudence Ive was appointed as CRS Principal Investigator in December 2008 and the site has continued with its record of success under her leadership. The Helen Joseph Hospital is a secondary level hospital, and part of the academic circuit of the Faculty of Health Sciences, University of the Witwatersrand. The research site is integrated with the HIV treatment centre, and TB focal-point, with over 27,000 HIV patients on care, treatment and support, the site is ideally suited to enrol patients in the current and future agenda of the ACTG network.
The ACTG site in Johannesburg, South Africa, is one of the leading international sites in the network, participating in a number of the network studies (5073, 5164, 5175, 5207, 5208, 5221, 5255, 5253 and the related sub-studies).
Key to the success of the research unit has been the exemplary follow-up of patients, with less than 1% of research participants being LTFU. “On the other hand, a particular positive is our very strong and efficient infrastructure that enables us to monitor adherence to programmes and offer counseling as and when required. Adherence to treatment regimens definitely makes a difference to patients,” she emphasises.
Dr. Prudence Ive
MBBCH, FCP(SA), DTM&H, Dip. HIV Man (SA)
Specialist physician, Dr. Prudence Ive has been a clinical investigator on the NIH-sponsored ACTG trials in the CIPRA-SA programme and ACTG network as site Principal Investigator at the Wits HIV Research Group (WHRG) based at the Helen Josef hospital in Johannesburg.
Dr. Ive completed both her undergraduate and post-graduate training at the University of the Witwatersrand, Johannesburg, South Africa. She obtained her diploma (cum laude) in tropical medicine and hygiene in 1997 and her HIV management diploma in 2004.
Dr. Ive was the medical director of the Themba Lethu HIV clinic from 1996 until 2005 during which time thousands of patients were initiated on antiretroviral therapy and a strong relationship was forged between the clinic and the WHRG. She joined the WHRG in 2000 but has maintained a consultancy relationship with the Themba Lethu clinic.
Currently the WHRG’s deputy director, Dr. Ive has been principal investigator on many HIV clinical trials, some of which were new drug development trials sponsored by the pharmaceutical industry. Dr. Ive was an investigator on the CIPRA 1 grant funded by the NIH and was part of the team that developed and successfully executed the protocol.
Dr. Ive continues to lecture and examine GEMP 4 medical students, mentors post-graduate researchers in the Health Economics and Epidemiology Research Office, and provides clinical teaching at post-graduate level in the Faculty of Health Sciences, University of the Witwatersrand.
(pictured above: Dr. Prudence Ive, Wits HIV Research Group ACTG Clinical Research Site Principal Investigator)