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Soldiers in the South African army.

Members of the South African National Defense Force.

Fighting AIDS in South Africa

December 13, 2005

The Associated Press recently reported that across Africa "hospital wards are filling with military casualties. The cause: not another African conflict--but AIDS." More deadly than any of the continent's wars, the disease is threatening the operations of the South African National Defense Force (SANDF), an organization that plays a vital peacekeeping role throughout Africa.

Military officials estimate that 23 percent of SANDF members are infected with the AIDS virus. It's a rate that mirrors the greater population of South Africa where 5 million people are infected--the highest HIV/AIDS caseload of any country in the world.

A collaboration that's led by SANDF, the U.S. Department of Defense, and the National Institutes of Health is responding to the epidemic with a groundbreaking clinical research program. The project, aimed at military staff and their families, includes a large randomized trial of treatments for those with advanced HIV and a follow-up study for those not infected or with earlier stages of the disease. Project Phidisa, which means "make better/prolong lives" in three of South Africa's home languages, aims to determine which antiretroviral drugs and treatments are most effective at managing the disease.

A team of faculty and staff from the University of Minnesota's School of Public Health (SPH) are working as advisors on the project. They include Jim Neaton, Alan Lifson, Merrie Harrison, Alain DuChene, Greg Thompson, and Terri Schultz. Neaton, a professor of biostatistics, and his group have been asked to use their more than 20 years of experience in building the infrastructure for large international clinical trials.

"Given the millions of people infected with HIV around the world, even small improvements in treatment can have a tremendous impact on global health," Neaton says. "And international collaboration is key."

Project Phidisa enrolled its first patients just a few months after it rolled out on World AIDS Day in 2003. Planning for the project began only six months earlier. "A multi-center study of this size and scope with such short lead-up time for implementation is fairly unprecedented," says Neaton.

The quick response can in part be credited to the SPH research team who, over the course of conducting other large clinical trials, had already developed and fine-tuned the data collection procedures and statistical software and hardware that were used in Project Phidisa.

HIV/AIDS facts

* The earliest known case of HIV-1 in a human was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo. (It is unknown how he became infected.)

* From 1979-81 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of male patients who had sex with other men.

* In 1982 public health officials began to use the term "acquired immunodeficiency syndrome" or AIDS. Formal tracking of AIDS cases began that year in the United States.

* In 1983, scientists discovered the virus that causes AIDS. The virus was named HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus) by an international scientific committee. The name was later changed to HIV (human immunodeficiency virus).

* Worldwide, close to 40 million people are living with HIV. In 2004 alone, nearly 5 million were infected and AIDS killed more than 3 million people.

Source: UNAIDS and Centers for Disease Control and Prevention

"It has worked for us for years, and now it's working well again," Neaton says.

More than 3,000 military members and their families have enrolled in the study at one of six clinical sites throughout South Africa. Those without advanced HIV are monitored, while those with advanced HIV are randomly assigned to one of four widely used combinations of drugs to compare their effectiveness, side effects, and compliance levels. Nearly 1,000 voluntary participants have enrolled in the clinical trial.

Two years into the five-year project the military is already reporting progress. Some of the most critically ill patients--those who were once confined to wheelchairs or hospital beds--are now returning to an active life.

"The drugs that have been developed are incredibly potent," says Neaton. "But there have been very few studies of how to optimally use these new drug combinations over the long-term to treat HIV."

Neaton hopes the findings of Project Phidisa will lead to more international partnerships and improved HIV treatments. He recently submitted a proposal to establish a novel global collaborative network to conduct AIDS research at some 400 sites in 37 countries.

"Given the millions of people infected with HIV around the world, even small improvements in treatment can have a tremendous impact on global health," Neaton says. "And international collaboration is key."