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Hughes Backs Institute at Epicenter of
HIV and Resistant TB in Durban, South Africa
  Science 27 March 2009:
Vol. 323. no. 5922, p. 1659
DOI: 10.1126/science.323.5922.1659
Robert Koenig
When HIV/AIDS researcher Bruce D. Walker and tuberculosis investigator William R. Jacobs made their pitch for a new research center in South Africa 2 years ago to the Howard Hughes Medical Institute (HHMI), the concept was foreign in more ways than one. HHMI had never built an institute outside the United States, and no other research center anywhere had focused its work entirely on the two diseases. But, says HHMI President Thomas Cech, "their logic was compelling." The two researchers and their South African collaborators argued that medical science would benefit from a direct engagement with the epidemics of HIV/AIDS and drug-resistant TB in a region that has been devastated by them. HHMI bought the idea.
Last week, Cech joined Walker, Jacobs, and South African researchers in announcing the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), a $60 million project on the campus of the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal (UKZN) in Durban. The medical school--the only one in South Africa where blacks were allowed to study during the apartheid years--already has a modern HIV/AIDS research wing funded by the Doris Duke Charitable Foundation.
"There is no better place on Earth to investigate the confluence of HIV/AIDS and drug-resistant TB," says molecular immunologist Malegapuru Makgoba, vice chancellor of UKZN. KwaZulu-Natal province is the epicenter of both epidemics in South Africa, which has the most HIV/AIDS cases (5.4 million) and one of the world's highest per capita rates of TB. What Walker calls a "cataclysmic convergence" of the two epidemics has been further complicated by the emergence in 2005 of extensively drug-resistant TB (XDR-TB) in the province's town of Tugela Ferry; it has since spread through much of the country (Science, 15 February 2008, p. 894). This week, the World Health Organization reported that one out of four TB deaths is HIV-related--twice as many as previously recognized.
The six-story K-RITH center will house two floors of biosafety level 3 labs equipped for TB research. "We have a unique opportunity here to study the capacity of the TB bacterium to become more resistant and more virulent," says acting director A. Willem Sturm, who has led South Africa's genetic analysis of XDR-TB. "But first we need rapid diagnostic tests" to determine drug resistance.
That's where Jacobs and his lab at the Albert Einstein College of Medicine in New York City come in. Using tests that employ engineered bacteriophages--viruses that infect bacteria--Jacobs believes his group will be able to reduce the time it takes to diagnose resistant TB from 4 weeks to a matter of days.
The HIV/AIDS team will pursue parallel objectives. Walker, based at Massachusetts General Hospital in Boston and Harvard University, also directs the HIV Pathogenesis Program in Durban. His research group will focus on the immune response to TB in HIV-infected people. "Understanding how the immune system responds to TB will be essential" in developing vaccines for TB and HIV, he says. Another research team, led by UKZN epidemiologist Salim Abdool Karim, will study patterns of TB latency and reinfection.
Cech says the institute has made a 10-year commitment to K-RITH. It will take more than a year to build the new center, starting in September. In the meantime, HHMI has awarded seed grants totaling $1.1 million to scientists who will be involved in K-RITH to jump-start research, as well as $3 million in grants to build temporary labs.
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