March 21, 2016
The Female Rising through Education, Support and Health cohort, or FRESH, located in the Umlazi Township outside of Durban, South Africa, is showing how basic science research can do more than just collect blood samples. Updates on work with FRESH are highlighted in other advocates’ reflections on CROI 2016.
The FRESH cohort—presented at CROI 2016—is a population of young women enrolled in a longitudinal study conducted by the Ragon Institute in Boston, MA and the University of KwaZulu-Natal in Durban South Africa. The purpose of the study is to identify young women (ages 18-23) in very early HIV infection—also known as “acute infection”—to study the innate, or primary, immune system and to address gaps in HIV prevention within this population.
In addition to biweekly clinic visits to draw blood, vaginal and cervical swabs, the women take part in an intensive training and education program to prepare them for jobs, entrepreneurship or reentry into the school system. The women attend two, three-hour classes per week over the course of 12 months. This intensive skills-building program was put in place to combat poverty in the population, a known driver of the epidemic, and help retain young women in the study.
The cohort began enrollment in 2013 and as of September 29, 2015, 699 women have been enrolled. Over 24 months 32 women were diagnosed soon after infection.
At the pre-CROI Community Cure Workshop, Zaza Mtime Ndhlovu (University of KwaZulu Natal) presented his research on HIV specific CD8 T cell responses in early infection. A subset of the cohort’s acutely infected women contributed to Dr. Ndhlovu’s research looking at T-cells directly before and after infection. Dr. Ndhlovu’s work shows that during the acute infection phase, HIV-specific CD8 cells develop very quickly and in high numbers. The number of HIV-specific CD8 T cells varies from person to person and contributes to the viral set point of the individual.
This means as soon as HIV enters the body, within the first few days, these HIV-specific CD8 cells can immediately begin fighting the virus. This is why the more HIV-specific CD8 responses an individual has the lower their viral set point. These HIV-specific CD8 T cells are prone to dying, so they don’t last long in the body.
This is significant because it offers a potential strategy toward HIV remission. If researchers can preserve these CD8 cells, either by preventing their death, by using a drug to enhance the immune system, or by priming the body to make more HIV-specific CD8 cells through a vaccine, they could potentially develop a “kill” component of a “kick and kill” curative strategy. The FRESH cohort is providing researchers with a new model of working with communities to prevent new HIV infections and conduct basic research toward a cure.