Working to Eliminate Pediatric HIV in the Developing World

Dr. Lisa Frenkel’s team is developing a simple test that couldimprove 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-infantHIV transmission. One current project is to create an inexpensive, easy-to-use test that quickly identifies drug-resistant HIV so people in the developingworld can get the right medicine the same day they are diagnosed.

Many pregnant patients in the Mozambican clinic whereDr. Lisa Frenkel studied HIV drug resistance traveled for hoursto get medical care. About 30% of the women had HIV, andFrenkel knew that – during birthing or breastfeeding – theywould unwittingly expose their infants to the virus. Around20% of these babies would become HIV-infected, and manywould 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 tomake the same progress in the developing world.”

During the last three decades, Frenkel has developedinnovative ways to detect HIV, improve treatment for thevirus and prevent mother-infant HIV transmission. Now herteam is creating the first affordable, easy-to-use test fordrug-resistant HIV strains that affect as many as a thirdof infected infants in the developing world.

Being able to quickly identify patients with drug-resistantHIV lets providers give them the right drugs immediatelyto help them survive and to reduce women’s chances oftransmitting 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. LisaFrenkel’s team so it can be run quickly and without sophisticated equipment.

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

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

Last year, the team started re-engineering the test withhelp from Drs. Barry Lutz and James Lai at the Universityof Washington. Their goal is to keep OLA affordable whilesimplifying it until it can be done with basic equipmentand 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 requiressophisticated equipment into a simple paper strip test that takes about30 minutes and can be read by the naked eye.

Lutz has access to some of the world’s most sophisticatedtechnology, but he has to think like a person who can’t useany of it. A bioengineering professor, Lutz develops testsand tools to be used in areas with few resources. He’sredesigning the part of OLA that analyzes a patient’s bloodsample; it currently involves more than nine steps, takesmore than five hours and requires a sophisticated instrumentto read the results.

Lutz helped develop a blood analysis prototype thatinvolves three simple steps, takes less than an hour andcan be read by the unaided eye. The key was transformingit into a paper strip test that technicians dip into a wellcontaining a patient’s sample and then into chemicals thatdetect HIV. Spots appear on the paper and indicate whetherthe patient has “wild type” HIV or a drug-resistant strain.

Lutz’s work illustrates how Frenkel’s team is transformingOLA until it can be performed in rudimentary labs whilepatients wait.

“Right now, people get first-line antiretroviral drugs evenif their HIV is resistant to them,” Frenkel says. “Our testwould let you immediately give people the drugs that couldsuppress drug-resistant strains and give the patient’simmune system a chance to recover.”

Tight NIH funding stalls progress

Frenkel and her UW colleagues have recently teamed upwith Epoch Biosciences Inc. to make OLA even simplerand are looking for funding to translate their prototypeinto a test, called OLA-simple, that could be mass-produced.It could be used in the developing world and as a moreaffordable option anywhere.

“Pediatric HIV has been nearly eliminated in the U.S. Ourgroup is developing practical ways to make the sameprogress in the developing world.”

Dr. Lisa Frenkel

Their recent grant application to the National Institutes ofHealth (NIH) scored in the top 7% of applications, but federalspending cuts have tightened NIH budgets and the team’sproposal missed the cutoff. Now they are raising a smallamount of money to help prove their concept works so theycan resubmit their NIH grant.

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

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

Published in Connection magazine, November 2013