Re: India's response to the HIV epidemic . The lancet: Vol 364,No9442.09

[Guest guest]

Re: India's response to the HIV epidemic . The lancet: Vol 364, No9442.09

The response by Drs. Prasada Rao, Ganguly, Mehendele and Bollinger to

Dr. Feachem's statement about the Indian AIDS trajectory being

distinct from the African trajectory nicely articulates the

differences between the African and Indian scenarios. (1) It also

corrects the widely held notion that there is no appropriate Indian

National response.

While I agree that a lot is being done nationally to slow down the

spread of AIDS, I wanted to add a different perspective on what is

lacking in terms of research. With help from colleagues located in

India (Drs. Udaykumar Ranga of JNCASR, V. Ravi of NIMHANS and S.

Vijaya of IISc), Bangladesh (Dr. GB Nair of ICDDR, and the US (Drs.

Jeymohan ph of NIMH, Dr. Ganjam Kalpana of Albert Einstein) I

recently organized " AIDS in India: A Regional Workshop-Symposium on

Research, Trials and Treatment " in Bangalore which was attended by

AIDS researchers in India, Bangladesh and Nepal. Being a molecular

Virologist working on HIV, I began the

conference with a complaint that 5.1 million infections is not matched

by appropriate numbers of HIV researchers in India. In fact, I cannot

count more than 8 or 9 HIV virologists working in India. This

observation set off discussions throughout the week-long meeting on

the reasons why we do not have many researchers dedicated to HIV

research. The observations that were made are instructive.

1. In the US, when AIDS disease came along, there were no 'AIDS

researchers' to start working on this problem immediately. Experts

in other related areas jumped in (this is not happening in India).

This appears to be mainly due to infusion of new monies made available

by the US government for AIDS Research.

Systematic RFAs (Requests for Application) and PAs (Program

Announcements) in specific fields where the NIH, particularly the

NIAID wished to stimulate research were put out by the NIH that kept

making additional funds available to specific areas in AIDS research.

In other words, the Govt. announced availability of funds to carry out

research in specific priority areas. The US scientists knew that they

could apply and compete for grants to carry out basic research on

those national priority areas.

The lack of such opportunities in India was agreed to be one main

deficit. While our resources may be limited, it is strongly felt that

the Indian Government should look into adapting this policy of

identifying priority areas in which research needs to be encouraged.

It seems the reasons for what prevents action in the above direction

are quite clear. That attitude is 'Why should we do more research on

HIV in India? It has already been extensively researched in the US

and elsewhere! " The problem is, very little is known about the clade C

HIV. There are distinct differences between clade B that has been

extensively studied and the clade C that pervades the Indian

subcontinent (1).

One difference was recently published in a collaborative research

paper by Dr. Udaykumar Ranga of Jawaharlal Nehru Center for Advanced

Scientific Research, Bangalore (2). Scientists at the NIMHANS (Drs.

Satishchandra and Shankar) had previously shown that the incidence of

HIV associated dementia in the Indian AIDS patients (who visit the

NIMHANS) do not get dementia as frequently as those here in

the US (30% vs. 0.5%) (3). Dr. Ranga's recent work shows that the

clade C Tat protein has a conserved genetic difference that is

responsible for the differential incidence. There are going to be many

more differences that are suspected, but could be proved soon.

Researchers outside India are unlikely to look into this extensively

since they have no access to this disease, the patients or the virus

sample. Who else to study this than the scientists in the affected

country? Thus, we urgently need more

HIV/AIDS researchers in India working on the Indian HIV epidemic.

2. A second deficiency that everyone pointed out is the lack of

appropriate biohazard containment facilities to grow HIV in

laboratories in India. Literally everyone who has the capacity to grow

virus in India was at the meeting. The number is appalling: a grand

total of THREE research laboratories that are equipped with the

Biohazard containment facility at a BL3 level (Drs. Udaykumar Ranga

(at JNCASR), Debashis Mitra (NCCS, Pune) and at NARI). This low number

has nothing to do with the Government of India nor is it the fault of

any funding agency. The facilities seem to be aimed at meeting the

demand. The real question is why isn't there any demand? Put another

way, why aren't more Indian Virologists being attracted to solving a

problem that seems very large? Another associated problem is the

following. Two of the three BL3 facilities in India are being used by

single AIDS research laboratories (the JNCASR one is being used by Dr.

Ranga and the NCCS one is being used by Dr. Mitra). This leads to the

next issue.

3. We need to build places that have focused groups of AIDS

researchers (somewhat like NARI in Pune) who all collaborate with each

other and benefit from each others' expertise in related areas and

many more people will be able to use the exclusive, expensive

facilities such as the above. In the US, there are a number of such

groups that have heavily contributed to understanding AIDS – examples

include Dr. Ho's Diamond AIDS Research Center and the

University of Alabama group. Plus, add to this the dozens of Centers

for AIDS Research (CFAR) set up by the NIH.

To this end, I have spoken to several Directors of research institutes

in India to recruit more AIDS researchers to create such a nucleus of

AIDS experts. One such nucleus now exists at NARI, but we need more.

I think the Government of India would make a tremendous contribution

to curbing AIDS by infusing money into basic AIDS research, building

more AIDS research facilities and creating groups of talented AIDS

researchers.

Sincerely,

V. Prasad

E-mail: prasad@...

References:

1. J V R Prasada Rao, N K Ganguly, Sanjay M Mehendale, C

Bollinger. India's response to the HIV epidemic. The lancet: Comment.

Volume 364, Number 9442,09 October 2004.

2. Shankarappa, R., R. Chatterjee, G. H. Learn, D. Neogi, M. Ding, P.

Roy, A.

Ghosh, L. Kingsley, L. on, J. I. Mullins, and P. Gupta. 2001. Human

immunodeficiency virus type 1 Env sequences from Calcutta in eastern

India:

identification of features that distinguish subtype C sequences in

India from

other subtype C sequences. J. Virol. 75:10479-10487.

3. Udaykumar Ranga et al. (2004) Tat Protein of Human Immunodeficiency

Virus Type 1 Subtype C Strains Is a Defective Chemokine. J. Virol,

78:2586-2590

4. Satishchandra, P., A. Nalini, M. Gourie-Devi, N. Khanna, V. Santosh, V.

Ravi, A. Desai, A. Chandramuki, P. N. Jayakumar, and S. K. Shankar. 2000.

Profile of neurologic disorders associated with HIV/AIDS from Bangalore,

south India (1989-96). Indian J. Med. Res. 111:14-23.

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Vinayaka R. Prasad, Ph. D.

Professor, Department of Microbiology and Immunology

Director, AIDS International Training and Research Program

Albert Einstein College of Medicine

1300 Park Avenue

Room GB 401

Bronx, NY 10461

Tel: 718-430-2517

Fax: 718-430-8976

Laboratory Homepage: http://www.aecom.yu.edu/prasadlab/

Research: http://www.aecom.yu.edu/home/sggd/faculty/prasad.htm

Fogarty AECOM-AITRP: http://www.aecom.yu.edu/aitrp/

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