August 2010

By Myron S. Cohen, MD

First of all, I’d like to welcome everyone back to Chapel Hill.  Back in April I wrote about the strength of UNC’s HIV/AIDS program (#8 in the most recent U.S. News & World Report rankings). So while this column is intended to cover a broad range of topics related to global health at UNC, it has been an exciting summer for HIV/AIDS research generally, and for UNC specifically, and I’d like to update you on some of these things.

Angela Kashuba (center) and the CAPRISA 004 team present study results at the Vienna AIDS conference

In June, we saw publication of the results of the massive, five-year BAN study in the New England Journal of Medicine. The study was conducted at UNC Project-Malawi by a team of investigators headed by Drs. Charles van der Horst and Charles Chasela (UNC) and Denise Jamieson (CDC). The study compared different methods to prevent nursing mothers who are HIV positive from transmitting the virus to their babies through breast milk.

Approximately 200,000 infants get HIV through breast milk each year, but the alternative, feeding formula, is expensive and requires clean water (more than a billion people worldwide lack access to safe water). The BAN study found that two different methods—giving antiretroviral drugs to the mothers or to the babies—are effective. The results of this important UNC research have now been incorporated into the World Health Organization’s breastfeeding guidelines.

At the end of June I headed to Washington, DC, to take part in a debate co-sponsored by the World Bank’s Global HIV/AIDS Program and the Office of HIV/AIDS at the United States Agency for International Development (USAID). This was the second in a series of high-level debates called Emerging Issues in Today’s HIV Response. My fellow panelists and I were presented with the following provocative statement: “Behavior change in generalized epidemics has not reduced new infections and is an unwise use of HIV prevention resources.”

For the purposes of the debate, I took a strong position arguing for the affirmative. HIV is a biological phenomenon, I argued, and requires a biological response: treat those infected (which makes them less infectious), develop a vaccine, or find a cure. The first is already being done, the second shows some promise, and the third not only seems possible, but is the focus of a large group of UNC scientists led by David Margolis and Victor Garcia-Martinez.

And finally, in July, UNC faculty and graduate students from many disciplines headed to Vienna, Austria for the XVII International AIDS Conference and presented literally dozens of abstracts on diverse HIV-related topics based on research conducted around the world.

The biggest news to come out of Vienna were the results of large study conducted in Durban, South Africa and is some of the most exciting and promising HIV prevention research in a long time. Known as CAPRISA 004, the study showed that a microbicide gel containing a popular antiretroviral drug reduced the risk of contracting HIV by 39%. Because the gel is applied in the vagina before and after sexual intercourse, it represents a powerful tool for women to protect themselves. UNC pharmacologist Angela Kashuba presented some of the study results, and Research Triangle-based FHI was one of the study partners, so this groundbreaking news is indeed a North Carolina victory.

And now we’re all back in Chapel Hill, and I know I speak for everyone at the Institute for Global Health & Infectious Diseases when I say that we are energized and eager to engage with our students and colleagues in every corner of the campus to find new ways to improve health at home, in North Carolina and around the world.