A Global Epidemic

By Alex Piazza
apiazza@umich.edu

Six months.

That is how long doctors expected Ryan White to live after being diagnosed with AIDS in 1984.

“I believed in miracles and I believed in cures, and I thought somehow someway my son was going to beat this,” said Jeanne White-Ginder, Ryan’s mother.

But as she later described it, her “nightmare was just beginning.”

Ryan contracted HIV from a blood transfusion when he was 13 years old. He later developed AIDS, leaving him vulnerable to various infections.

But Ryan far surpassed the doctors’ expectations for recovery and gained notoriety for his courageous battle with AIDS, which ended in 1990.

White-Ginder visited the University of Michigan as part of its commemoration of World AIDS Day, where she stressed the importance of testing and continued research.

Rogério M. Pinto, who introduced White-Ginder at the event, is among a cohort of U-M researchers in fields ranging from social work to public health who are working to address the global HIV epidemic.

“More than 36 million people worldwide are living with HIV,” said Pinto, professor and associate dean for research at the U-M School of Social Work. “Those numbers are unacceptable, and we have to work together to keep that number from rising because people are suffering every day.”

Searching for a Cause and a Cure

In 1981, the U.S. Centers for Disease Control and Prevention published an article about a rare lung infection found in five men in Los Angeles.

It was the first official reporting of what later became known as the AIDS epidemic.

By the end of the year, there were more than 300 reported cases of AIDS in the U.S. That number jumped to 100,000 by 1989.

Kathleen Collins was a medical student in Baltimore at the time and witnessed the deadly epidemic firsthand.

“In my very first rotation on the wards, I took care of a 5-year-old girl who was born with AIDS and was dying,” she said. “That was a very poignant situation because she didn’t deserve to die that way, and it was hard to feel like nobody could do anything to cure her.”

Thirty years later and now a professor of microbiology and immunology at U-M, Collins continues to study the deadly disease.

HIV is transmitted through certain bodily fluids, and once the virus reaches the body, it weakens the immune system, thus increasing the risk for many infections and cancers that rarely affect people with healthy immune systems.

Medication can help control the virus, but if left untreated, HIV replicates within the body and wipes out important immune cells that keep people healthy. Once enough immune cells are eliminated, a person can develop AIDS, which severely inhibits their ability to fight off infection.

“People with AIDS are continuously battling these opportunistic infections until they eventually succumb to one,” said Collins, associate director of the U-M Cellular and Molecular Biology Program.

Her research focuses on a protein that conceals cells infected with HIV, making it harder for the immune system to do its job. With support from a number of federal agencies, including the National Institute of Allergy and Infectious Diseases, Collins is working with colleagues across disciplines to identify new drug candidates that can inhibit the protein and allow the immune system to better attack HIV.

Her team screened thousands of small molecules at the U-M Center for Chemical Genomics in search of a new drug candidate, but none of them showed promise. Collins then turned to Professor David Sherman, an avid scuba diver who collects microorganisms underwater to help pioneer new antibiotics, anticancer drugs and other medicines.

Collins screened Sherman’s collection and found some molecules that show potential to inhibit the protein. She now is working with Sherman and others to perform more tests in hopes that one molecule stands out in its ability to treat HIV.

“One of the things I love about studying viruses is they teach you so much about the way our body works,” she said. “HIV is so highly evolved, and so it’s fascinating to see how this particular virus is able to evade the ways in which our body identifies and counteracts infections. It’s further motivation for me to eradicate this virus.”

Barriers to Treatment and Prevention

The numbers still stagger Rogério M. Pinto.

Much progress has been made in regard to HIV prevention over the past three decades, yet 1.8 million people worldwide became infected with HIV in 2017, including 180,000 people younger than 15.

“We know so much from a biomedical and behavioral standpoint, but we have not tackled as fiercely the structural barriers to both prevention and treatment,” said Pinto, whose research focuses on uncovering factors that facilitate and/or hinder patient access to HIV prevention and treatment services.

With support from the National Institute of Mental Health, Pinto and collaborators at the U-M Interprofessional Collaboration Implementation Group are working to develop behavioral and structural interventions that could mitigate barriers that keep underserved populations from accessing an important HIV drug.

Pre-exposure prophylaxis (PrEP) is a daily pill that can help people who are vulnerable to acquiring HIV. Medicine contained in the pill can help keep the virus from establishing a permanent infection.

Pinto understands its benefits, so he and his colleagues identified 30 potential barriers to accessing PrEP, as well as 31 potential solutions to those barriers.

Their findings show one striking barrier to accessing PrEP—healthcare providers’ lack of knowledge and biases toward those who most need the drug. Providers appear to believe that certain patients, such as transgender women and people of color, may be unable to consistently adhere to prescribed regimens or will stop using condoms to prevent HIV transmission.

In order to counteract these biases, Pinto and his colleagues are developing a training intervention for providers of social, public health and primary care services to improve cultural competency and better identify patients who could benefit from PrEP.

“There are a number of barriers that keep people from accessing PrEP, and so our research highlights the fact that multiple interventions should be adopted to counteract these obstacles,” Pinto said. “We also have to understand that HIV doesn’t happen in a vacuum. It happens disproportionately to populations that have been historically underserved and stigmatized. That’s why it’s critical for us to continue building community partnerships so that we can combat HIV on a behavioral and structural level, and advance social justice.”