Researchers look for answers to HIV

Centralised repository of samples from AIDS patients being set up

Why is it that some Indians who are exposed to the Human Immunodeficiency Virus (HIV) don’t get Acquired Immunodeficiency Syndrome (AIDS)? How do the anti-HIV and anti-tuberculosis drugs interact with each other inside patients who have both the diseases? What is the pattern of drug resistance in the HIV-positive population?
 
These are just three of the many crucial questions that Indian researchers might be able to answer by tapping into a centralised repository of serum samples that the government is building. The samples would be collected from AIDS patients, and from people who are at a high risk of contracting it.

 
Think of it as a centralised library, where not just samples but other epidemiological data such as incidence and distribution of disease, medical history and social behaviour of a particular population — for example, men who have sex with men or intravenous drug users —are characterised, catalogued and periodically updated. According to UNAIDS, India has 2.1 million people living with HIV, third highest after South Africa and Nigeria in the world.
 

The Department of Biotechnology and Indian Council of Medical Research (ICMR) pooled in Rs 20.8 crore in August this year, to set up this repository, which would most likely be housed in the National AIDS Research Institute, Pune. The partner research institutes are currently finalising standard operating procedures of collecting the samples and data. This mechanism would be used to harmonise the data that already exists with Indian research institutes working on AIDS, before linking all the data together.

 
In the next phase, this database would be expanded by reaching out to the populations of interest — people who are exposed to the virus but don’t get AIDS, people who are at a high risk of getting AIDS, the ones who are on AIDS treatment, who just got AIDS, people showing resistance to anti-HIV drugs, and people who have AIDS plus other diseases such as tuberculosis or hepatitis C. “This is going to be a very rich data,” said Sanjay Madhav Mehendale, additional director general of ICMR. “We’d be able to tell researchers, look we have this massive data, what do you want to study?” he added. A mechanism would be developed for researchers to use the database.

 
So far, scientists who were trying to understand different aspects of AIDS had access to comparatively small sets of populations. And some of the research methods were not of standards or internationally acceptable. “This will be an opportunity to work with large pan-India cohorts,” said Sundeep Sarin, Advisor and Scientist G, Department of Biotechnology, Government of India. 

It would be something on the lines of The Multicenter AIDS Cohort Study in the US, which began in 1984 to study HIV infection in homosexual and bisexual men.
 
The participants are seen every 3-6 months. They donate blood and answer a long list of questionnaire. The study has produced about 1,200 papers so far. Researchers have identified individuals who are resistant to HIV infection. Understanding the mechanisms of that resistance is likely to help in developing protective interventions.

 
Studying a specific population at the national level not only gives better insights about the behaviour of that population but also about the disease and the virus, according to Rajat Goyal, country director (India) of International AIDS Vaccine Initiative, which is facilitating this initiative. “In many countries, such cohort studies are a part of health policy, then why not in India?” said Goyal. Mehendale, Goyal and Sarin said that it is important for us to study the biology of Indian population and the virus that affects it for designing interventions that work best here. A particular type of HIV virus subtype ‘C’ affects the Indian population.

 
However, a centralised database of this kind also raises questions about data security because a good part of this data might involve confidential patient information. “We plan to keep the data anonymous,” said Mehendale. “We will put in the best firewalls in place to protect the data.”
 
While it remains to be seen how the government does that, there are other challenges that the ICMR needs to tackle. Maintaining this repository would require periodical and long-term follow-ups of the HIV-positive people and those who are at a high risk of getting it. Some of them keep migrating. “Tracking them will be a challenge,” added Mehendale.

 
Going Deeper

• India has 2.1 mn people living with HIV, the third highest after South Africa and Nigeria, according to UNAIDS
• The Department of Biotechnology and Indian Council of Medical Research pooled in Rs 20.8 cr for the repository
• The repository would most likely be housed in the National AIDS Research Institute, Pune