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Working to Eliminate Pediatric HIV in the Developing World

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Dr. Lisa Frenkel’s team is developing a simple test that could improve HIV treatment and reduce mother-infant transmission.

Dr. Lisa Frenkel

During the last three decades, Dr. Lisa Frenkel has developed innovative ways to detect HIV, improve treatment for the virus and prevent mother-infant HIV transmission. One current project is to create an inexpensive, easy-to-use test that quickly identifies drug-resistant HIV so people in the developing world can get the right medicine the same day they are diagnosed.

Many pregnant patients in the Mozambican clinic where Dr. Lisa Frenkel studied HIV drug resistance traveled for hours to get medical care. About 30% of the women had HIV, and Frenkel knew that – during birthing or breastfeeding – they would unwittingly expose their infants to the virus. Around 20% of these babies would become HIV-infected, and many would eventually develop AIDS and die from the disease.

“Pediatric HIV has been nearly eliminated in the U.S.,” Frenkel says. “Our group is developing practical ways to make the same progress in the developing world.”

During the last three decades, Frenkel has developed innovative ways to detect HIV, improve treatment for the virus and prevent mother-infant HIV transmission. Now her team is creating the first affordable, easy-to-use test for drug-resistant HIV strains that affect as many as a third of infected infants in the developing world.

Being able to quickly identify patients with drug-resistant HIV lets providers give them the right drugs immediately to help them survive and to reduce women’s chances of transmitting HIV during pregnancy, birthing and breastfeeding.

Simplifying a complex test

Dr. Barry Lutz

Dr. Barry Lutz, a bioengineering professor at the University of Washington, is working to simplify an HIV drug resistance test developed by Dr. Lisa Frenkel’s team so it can be run quickly and without sophisticated equipment.

While it’s standard practice to test patients for drug-resistant HIV in developed countries like the U.S., the test costs upwards of $500, making it cost-prohibitive in the developing world.

In the early 1990s, Frenkel’s team developed OLA, a test for HIV drug resistance. Although OLA costs only about $3 for the supplies per patient, it includes more than a dozen complicated steps and takes medical labs about 13 hours to complete. This creates challenges in the developing world, where many lab technicians don’t have the skills to perform OLA, and patients often live too far from clinics to come back for their results. 

Last year, the team started re-engineering the test with help from Drs. Barry Lutz and James Lai at the University of Washington. Their goal is to keep OLA affordable while simplifying it until it can be done with basic equipment and little training.

Detecting HIV more easily

OLA-simple prototype

This prototype, developed by Lutz’s team at the UW, turns a complex, five-hour blood analysis test that requires sophisticated equipment into a simple paper strip test that takes about 30 minutes and can be read by the naked eye.

Lutz has access to some of the world’s most sophisticated technology, but he has to think like a person who can’t use any of it. A bioengineering professor, Lutz develops tests and tools to be used in areas with few resources. He’s redesigning the part of OLA that analyzes a patient’s blood sample; it currently involves more than nine steps, takes more than five hours and requires a sophisticated instrument to read the results.

Lutz helped develop a blood analysis prototype that involves three simple steps, takes less than an hour and can be read by the unaided eye. The key was transforming it into a paper strip test that technicians dip into a well containing a patient’s sample and then into chemicals that detect HIV. Spots appear on the paper and indicate whether the patient has “wild type” HIV or a drug-resistant strain.

Lutz’s work illustrates how Frenkel’s team is transforming OLA until it can be performed in rudimentary labs while patients wait.

“Right now, people get first-line antiretroviral drugs even if their HIV is resistant to them,” Frenkel says. “Our test would let you immediately give people the drugs that could suppress drug-resistant strains and give the patient’s immune system a chance to recover.”

Tight NIH funding stalls progress

Frenkel and her UW colleagues have recently teamed up with Epoch Biosciences Inc. to make OLA even simpler and are looking for funding to translate their prototype into a test, called OLA-simple, that could be mass-produced. It could be used in the developing world and as a more affordable option anywhere.

“Pediatric HIV has been nearly eliminated in the U.S. Our group is developing practical ways to make the same progress in the developing world.”

Dr. Lisa Frenkel

Their recent grant application to the National Institutes of Health (NIH) scored in the top 7% of applications, but federal spending cuts have tightened NIH budgets and the team’s proposal missed the cutoff. Now they are raising a small amount of money to help prove their concept works so they can resubmit their NIH grant.

“It’s a tricky funding climate, but that won’t stop us from bringing OLA-simple to countries where people need it most,” Frenkel says.

To find out how you can help, email Brenda Majercin or call 206-987-4979.

Published in Connection magazine, November 2013

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