decade of collaboration in Thailand Sharon R Lewin Professor and Head, Department of Infectious Diseases Alfred Hospital and Monash University Co-head, Centre for Biomedical Research, Burnet Institute, Melbourne, Australia Track A Workshop Linking Clinical Cohorts and Basic/ Clinical Science, IAS2013, Kuala Lumpur, Malaysia
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Lessons from a decade of collaboration in Thailand
Sharon R LewinProfessor and Head, Department of Infectious Diseases Alfred Hospital and Monash UniversityCo-head, Centre for Biomedical Research, Burnet Institute, Melbourne, Australia
Track A Workshop Linking Clinical Cohorts and Basic/
Clinical Science, IAS2013, Kuala Lumpur, Malaysia
HIV-HBV co-infection
350 million
Hep B
HBsAg+
33 million
3 million
HIV
HIV NAT: Netherlands Australia Thailand
David Cooper Joep Lange Praphan Phanuphak
Kiat Ruxrungtham
Anchalee Avihingsanon
the beginning – tenofovir in co-infection (TICO)
The beginning: TICO
2005
LAM / TDF / EFV
AZT / TDF / EFVn=36HIV/HBVNaïve to ART
AZT / LAM / EFV
0 24 48
TICO: Tenofovir in co-infection Greg Dore
PBMC
Liver biopsy
+ + + + + + +
TICO: evidence for combination anti-HBV therapy (WHO, DHHS, IAS)
Excellent clinical research infrastructure from HIV NAT was critical
Well designed small RCTs with appropriate tissue and blood stored can have a significant impact
Significant natural history studies require long term investment
Capacity building and impacts on patient care should be a top priority
Challenges
Costs of training and infrastructure for basic science in low income countries are substantial
Opportunities for local funding in basic science and/or clinical research often limited which has an impact on sustainability
future directions
Study of Fibrosis and Immune Activation (SOFIA)
2013
X-sectional (n=70)
2016
BxPBMCPlasma
Mel/Syd (n=30)Thailand (n=40)
Longitudinal (n=100)Mel/Syd (n=70)Thailand (n=30)
PBMCPlasma
PBMCPlasma
PBMCPlasma
PBMCPlasma
PBMCPlasma
PBMCPlasma
HIV Cure studies
Critical that these are also performed in low income countries– Different HIV genotypes– Different levels of immune activation– Community engagement
Thailand already a leader in the field– Early acute infection– Access to tissue
Intervention studies soon to startJintanat
Ananworanich
Conclusions
Well designed RCTs and cohort studies with stored tissue are a tremendous resource to ask new research questions as the clinical landscape changes
The investment pays off in publications, grants, training and clinical care
Multiple opportunities for capacity building but significant investment is needed to ensure sustainability
AcknowledgementsHIVNAT, Bangkok, ThailandKiat RuxrungthamAnchalee AvihingsanonSasiwimol UbolyamPraphan PhanuphakJintanat AnanworanichMonash University, MelbourneJudy ChangMegan CraneDavid IserJen Audsley Alfred Hospital, MelbourneJoe SadadeuszWill KempVIDRL, MelbourneStephen LocariniScott BwodenPeter RevillNadia WarnerKirby Institute, UNSW, SydneyGail MatthewsGreg DoreDavid Cooper
Johns Hopkins, Baltimore, MDChloe ThioEric SeabergSt Vincents Hospital, MelbournePaul DesmondAlex ThompsonAmsterdam Institute for Global Health and DevelopmentJoep Lange