Accounting for genetic diversity in HIV/AIDS treatment in sub-Saharan Africa

SPARK is a translational research
program that helps academicians take early discoveries in biomedicine and
mature them to a project that can impact patients and society. In 2011 two professors at Stanford invited
Collen Masimirembwa to come and give a talk at Stanford. In that talk he
highlighted the fact that drugs that are used to treat patients with HIV/AIDS,
a component of a drug, called Efavirenz, is metabolized in sub-Saharan
Africans very differently from Caucasians. Over 30 to 40 percent of the people in
Zimbabwe had very bad reactions to this drug whereas in Europe only 5 percent, so
we have come up with a genetics tool which helps us to identify those 40 percent who
are likely to have very serious adverse drug reactions and those would be given
a drug dose which is individualized or personalized to their genetic makeup. I
went to the World Health Summit in Berlin where I talked to one of the people in
charge of distributing the drug in sub-Saharan Africa. And what he told me
is that the reason why HIV/AIDS is still common in sub-saharan Africa and in
Zimbabwe is because patients don’t take their medication. And then he said it is
a cultural thing. And I think that attitude was rather the trigger for me
to become more involved in this project. First, you don’t bring in drugs
that don’t work on your people. And when they come you give them at the right
dose, which do not create a new disease — sort of adverse drug reactions which you
now also have to treat. And for us to understand how to translate that
knowledge and finding into a clinical solution, that was one of the reasons why
we sent some of our students for training on how do you translate a lab
result into a clinical solution. I talked more with Collen and clearly
there was a need to identify a test that will distinguish the metabolism rate
from one patient to the other. So the idea that we had was to bring students
from Zimbabwe to Stanford to help them develop this assay and automated it so
that they can apply it back in sub-Saharan Africa
and then develop a clinical trial that could show whether the drug is equally
efficacious when those appropriate to the genetic traits that determines the
metabolism of the drug. Sending those cohorts of students for training helped us
to come up with the solution which we called Gene-Dose which is now a clinical
solution to addressing the side-effects of the antiretroviral drugs, so we believe
this is a very clear result or outcome from this interaction within
the SPARK family. The story of SPARK Zimbabwe and
specifically the projects that Collen Masimirembwa is running in the AiBST is
a perfect exemplification that know-how, smarts, experience is not restricted
geographically, that there are terrific scientists everywhere in the world and
many of them are making discoveries that can impact patients not only locally
as in the case of Collen but also globally. Instead of me just depending on two
experts in genetics in Zimbabwe, I can now access hundreds. Then secondly,
we do not have a history or a tradition of translational research and SPARK is made
up of people who have explored this value chain. So, Africa can then tap into
those diverse experiences of how to transition from discovery, development,
and deployment of products. And by being a member of SPARK we become
beneficiaries of the collective skill.