Salim and Quarraisha Abdool-Karim, a South African husband-and-wife research team, have been awarded the prestigious Lasker Prize, often called "America's Nobel," for their pivotal contributions to HIV prevention and treatment. Their work has particularly focused on addressing the disproportionately high rates of HIV infection among young women in South Africa.
Identifying a Critical Disparity
In the early days of the AIDS epidemic, the Abdool-Karims identified a critical disparity in HIV infection rates. While in the U.S. and Western countries, HIV was predominantly affecting gay men, their research in South Africa revealed that young women were particularly vulnerable. "Our study that we did back in 1989-1990 produced data that took us quite by surprise," Salim Abdool-Karim explained. "When we looked at the information from this large community survey, we found that in teenage boys, the prevalence of HIV was quite low. But if you looked at teenage girls, they had very high rates of infection."
This discovery highlighted that these young women were primarily contracting HIV from older men, prompting the couple to focus on developing prevention methods that women could control themselves.
Development of Tenofovir Gel
After nearly two decades of research, the Abdool-Karims achieved a breakthrough with Tenofovir, an antiretroviral drug. Their trials demonstrated that Tenofovir, when used as a vaginal gel, could effectively prevent HIV transmission in women. "When we announced in 2010 that we had shown that this drug called Tenofovir... protected women against HIV when used in a gel, it provided new hope to the field of HIV at the time," Salim noted.
Although the gel faced challenges related to cost and efficacy compared to oral Tenofovir, this research paved the way for pre-exposure prophylaxis (PrEP) strategies. By 2015, the World Health Organization recommended Tenofovir-containing PrEP for individuals at high risk of HIV infection.
Addressing PrEP Adherence and Long-Acting Technologies
Despite the effectiveness of oral PrEP, the Abdool-Karims recognized challenges in adherence, particularly among young women. "Our problem became that young women were not overly keen to go and stand in a long queue at a clinic to collect tablets to take to prevent a disease they didn't have," Salim stated. This led them to explore long-acting prevention technologies.
Promising Results with Lenacapovir
Their recent work with Lenacapovir, a long-acting injectable antiretroviral, has shown promising results. "That study showed that if you take the injectable of Lenacapovir, it was highly effective. In fact, there were no infections in women who took this injection," Salim reported. This approach offers the potential for women to receive an injection every six months, significantly reducing the burden of daily pill adherence.
Future Directions
The Abdool-Karims are now focused on developing an annual long-acting prevention technology, potentially in the form of an implant. This could release Tenofovir slowly over a year, further simplifying HIV prevention for women.
Overcoming Apartheid and AIDS Denialism
The Abdool-Karims' journey has been marked by significant challenges, including growing up under apartheid and navigating AIDS denialism within the South African government. Despite these obstacles, their dedication to scientific research and public health advocacy has had a profound impact on the HIV epidemic in South Africa and globally. Their work has contributed to a significant drop in new HIV infections in South Africa, from approximately 500,000 in 2000 to 150,000 last year.
Quarraisha Abdool-Karim reflected on the difficulties during the era of AIDS denialism, "It was a particularly painful time in that when we first started doing AIDS research in South Africa, we were dealing with a silent epidemic... and in 2000, when we hosted the International AIDS Conference, this is coinciding with the president, the democratically elected president, challenging this."
Their receipt of the Lasker Prize is a testament to their unwavering commitment to scientific excellence and their profound impact on global health.
