Military Medicine

[Under Reported]

Military Medicine
Two leaders on the front lines of HIV research often go unrecognized
by Mariel Selbovitz, MPH

camoThe U.S. is the global leader in the fight to end the AIDS crisis, funding seventy percent of all HIV treatment, care and prevention worldwide. Almost universally, when people think of the most important programs to control and potentially result in an “AIDS Free Generation,” they think of NIAID and PEPFAR. However, there is a lesser known program in the U.S. military that is an important ally in the U.S. government’s efforts to bring about an end to the AIDS crisis.

The U.S. Military HIV Research Program (MHRP) is the world’s elite force in the war on HIV. The program gained some attention for the RV144 trial, which is the only HIV vaccine trial to date that has shown any efficacy. The original results were published in 2009 in the New England Journal of Medicine. MHRP has since conducted several studies to determine correlates of risk that will inform the design of an effective HIV vaccine. In addition to RV144, MHRP is conducting studies on several different vaccine candidates.

But MHRP is more than a leader in HIV vaccine research. First, MHRP is heavily engaged in executing large PEPFAR programs in Africa. Second, the program has developed novel approaches to study acute HIV infection, an understanding of which is essential to develop a strategy to eradicate HIV or induce drug-free remission. Acute HIV is the earliest period of infection during which viral load is high and the latent reservoirs are established. During acute infection HIV damages the host immune system in ways that are critical to the progression and long-term outcomes of the disease.

It is extremely difficult to identify patients in the acute stage of infection, but MHRP has developed two studies in Africa and Thailand that have successfully enrolled more than 300 people during this early stage—some within only days of infection. Later this year, the program will begin several HIV remission/cure studies with therapeutic vaccines and other interventions followed by antiretroviral treatment interruption to evaluate the benefit of these. All volunteers will be closely monitored twice per week, and placed back on therapy immediately if needed.

Col. Nelson Michael, MD, PhD, serves as the Director of MHRP. Col. Michael also sits on several federal HIV advisory and scientific boards, and has received several international awards including the Hero of Military Medicine Award in 2013. He is one of the world’s leading advocates for accelerating the search for a safe and effective HIV vaccine. Despite the critical research conducted by the program and its exceptional leadership, MHRP remains less well-known among HIV research programs in the world.

MHRP works in partnership with another military HIV research program, the Infectious Disease Clinical Research Program (IDCRP) headquartered at the Uniformed Services University, “America’s Medical School.” The IDCRP conducts HIV research among domestic military personnel with a focus on health, longevity, and full function. They ask tough questions and aggressively seek answers, by conducting broadly collaborative research in large part through their U.S. Military HIV Natural History Study (NHS).

Since 1986, this one-of-a kind cohort study has enrolled more than 5,800 HIV-infected active duty personnel and beneficiaries, collecting data as well as blood specimens into a highly valued repository. The active duty force is a well-screened population with open access to healthcare and medications, which enables researchers to capture data on clinical events and disease progression. The population is healthy, racially diverse, educated, and has fewer confounders that plague other cohort studies. Combined, these assets have resulted in hundreds of published manuscripts that have advanced the fields of HIV research and care and treatment. At present, these aspects are being leveraged in many studies, including toward understanding and predicting individual risk of non-AIDS-related complications.

These two DoD programs, MHRP and IDCRP, are funded through a variety of sources including the military and also NIAID, which values the unique contributions of these military research programs. They both conduct important research and have exceptional clinical trial capabilities, both internationally and in the U.S. The programs have collaborated on many studies and published papers on the impact of race in HIV disease progression, insights into immune reconstitution inflammatory syndrome, and host responses/factors early in infection that affect longer term outcomes.

Many people do not realize that the U.S. military contributed to the development of eight U.S. licensed vaccines. MHRP and IDCRP continue this long military tradition of successfully fighting infectious diseases through their work in HIV. They are critical tools in our effort to bring about an end to the AIDS crisis, which will require the development of an effective vaccine, better treatments, and hopefully, one day, new strategies for HIV remission or cure. It’s time they are recognized for their contributions.

Mariel Selbovitz, MPH, wrote about dual-tropic entry inhibitors in this month’s Treatment Horizons.