THE FRENCH NATIONAL AGENCY FOR RESEARCH ON AIDS & VIRAL HEPATITIS Dr Didier Laureillard, ANRS, HCMC...
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Transcript of THE FRENCH NATIONAL AGENCY FOR RESEARCH ON AIDS & VIRAL HEPATITIS Dr Didier Laureillard, ANRS, HCMC...
THE FRENCH NATIONAL AGENCY FOR RESEARCH ON
AIDS & VIRAL HEPATITISDr Didier Laureillard, ANRS, HCMC
[email protected]/07/2013
Titre document / Le 15 - 09 - 2013
1
ANRS
Introduction Public agency, created in 1992, aimed at funding and coordinating research in all areas relevant to HIV/AIDS and viral hepatitis As of 1/01/2012, an autonomous agency within INSERM (Institut National de la Santé et de la Recherche Médicale) in 2013 Annual budget of research: 48 Millions € (total equivalent to 125 millions €) Supported by:
• Ministry of Research (39M€)• Ministry of Health• Ministry of Foreign Affairs• Institutional partners : INSERM, CNRS, Pasteur Institute, IRD, Esther
Scientific Advisory Board:• 50% of whose members are from outside France • President: Pr Françoise Barré-Sinoussi
ANRS
ANRS Scientific Advisory Board
Pr Barré Sinoussi Françoise – Chair
Pr Vella Stefano – Co-Chair
M’Boup Souleymane
Moradpour Darius
Negro Francesco
Persiaux Renaud
Reiss Peter
Schechter Mauro
Trepo Christian
Weller Ian
Alcami José
Barin Francis
Ball Andrew
Davril Juliette
Douek Daniel
Fischer Hugues
Lerderman Michael
Lert France
Levrero Massimo
ANRS
Commitment to all areas of research
Basic research
Vaccine research
Clinical, therapeutic and epidemiologic research
Research in public health and the human & social sciences
Research in resource limited countries
ANRS
Researchers are : clinicians, biologists, social science specialists
They are based in the laboratories of INSERM, CNRS, Pasteur Institute, IRD, and universities and hospitals Some of them are not working in France but are based in other countries
Who are the researchers ?
ANRS
ANRS « Scientific performance »
• 550 publications/year
• Approximately 50% of publications have IF > 5.
• 1% of ANRS publications are in the 10 top international journals
• 6,2% of ANRS publications (HIV/AIDS and hepatitis) are in the 1% group of excellence (number of citations), higher than the national average in the field of biology/health
• France is ranked 2nd or 3rd international position in the field of HIV and 2nd in the field of hepatitis
ANRS
ANRS Funding Mechanisms
• 2 main calls for proposals/year
• Top-down vaccine research programme
• Clinical Trials: AC5/AC24 committees for approval and funding
• ANRS: essentially only funder for HIV and viral hepatitis research in France
• ANRS: funds research, but not institutions, nor salaries
ANRS
% Distribution of funds according to research area 2012 (44 M €)
• Basic Science HIV 14 %
• Vaccine HIV-HCV 12 %
• Clinical trials and cohorts (HIV) 26 %
• Epidemiology/socio-behavioral science 7 %
• Resources limited countries (HIV-Hepatitis) 22 %
• Hepatitis B and C 19 %
GLOBAL HEPATITIS 24% (11 M €)GLOBAL BASIC SCIENCE : 39% (17 M €)
ANRS
4 main ANRS priorities HIV
• Study reservoirs with the objective of eradication or functional cure
• Testing: Novel methods; Early and better treatment
• Prevention of new infection with a biomedical approach
• Develop new vaccine strategies
With a NORTH SOUTH vision Integrating economic aspects
ANRS
• Molecular mechanisms involved in cell-virus interactions
• Relationships between fibrosis, inflammation and viral replication
• Strategic evaluation of new molecules anti HVC (Cohorte, co-infections...)
• New tools for prevention
• HBV Cure
5 main ANRS priorities Hepatitis
+ research priorities in Social and Health Science:- Hepatitis B and C among drug users and inmates- Screening strategies of HCV and HBV chronic infection,
including rapid tests, - Modeling of HCV transmission among drug users
ANRS
Research in resource-limited countries
ANRS
Developping countries department
By 1994, the ANRS started to fund research projects in many resources-limited countries, and has set up sites in Africa, Asia and South America
A specific department and a specific scientific and review board (CSS6) were set up
2 calls for grant/year: 15 of March & 15 of September
In 2012: ¼ of its budget (ie, ≈12 millions €) to research on HIV/AIDS and viral hepatitis in these countries
≈ 70 ongoing projects
ANRS
ANRS in resource limited countries
ANRS
Ongoing projects in resource limited countries in 2013
ANRS
ANRS in Viet Nam
ANRS
Introduction Collaborations between French and Vietnamese researchers began in 1988.
6 January 2000: official agreement between Vietnam Ministry of Health and ANRS for collaboration and creation of an ANRS site in Viet Nam
Most ANRS-funded studies were conducted in Ho Chi Minh City, with support from Pasteur Institute and the city’s hospitals, in the framework of national (VAAC) and provincial (PAC) programs in the fight against HIV/AIDS.
The studies now extend to the north of the country, notably in Hài Phòng.
13th of March 2014: Official agreement for collaboration with Hanoi Medical University
ANRS
ANRS Site Coordinators
French Coordinator Vietnamese Coordinator
Pr Françoise Barré-SinoussiPasteur InstituteParis, France
Pr Truong Xuan LienPasteur Institute Hô Chi Minh City, Viet Nam
ANRS
Training & Training &
technology transfertechnology transfer
Social sciencesSocial sciences
- Sexual behaviors & HIV/AIDS
- Social determinants of access to
care for children living with HIV
2 projects
More than 10 years of collaboration
Basic researchBasic research
Biological characterizations of HIV-1Immune & genetic determinants of
protection
7 projects7 projectsClinical researchClinical research
Improving diagnostic & treatment of
patients infected by HIV & associated
diseases (TB, Hepatitis…)
14 projects (5 ongoing)14 projects (5 ongoing)
18
ANRS
Ministry of health Vietnam
Ministry of health Vietnam
ANRS France
ANRS France
Co-ordinationTruong Xuan Lien & F.Barre-Sinoussi
-Pasteur Institute HCMC-Health service HCM & Hải phòng-PAC HCMC & Hai phong-Pham Ngoc Thach Hospital-Pediatric Hospital n°1 & 2-National Pediatric Hospital-OPC HCMC & Hải phong-Việt Tiệp Hospital Hai phòng-Medical University Hải phòng-Southern Institute of Social Sciences- Vietnamese academy of social sciences-Institute for Population and Social-Studies, National Economics University 19
A lot of partnerships
-Institut Pasteur Paris-Université d’Aix Marseille III-Université Victor Segalen, Bordeaux -Kremlin Bicêtre hospital, Paris-European G.Pompidou hospital, Paris-Necker hospital, Paris-Pitié-Salpétrière hospital, Paris-Saint Antoine hospital, Paris-INSERM-Montpellier medical University-IRD, Marseille et Montpellier-ESTHER
ANRS
ANRS funded ongoing projects in Viet Nam
ANRS
ANRS 12150 – RAPPharmacokinetics of rifabutin with antiretroviral
therapy in the treatment of tuberculosis patients with
HIV infection in in Ho Chi Minh City
33 TB-HIV co-infected patients enrolled End of clinical activities: october 2012 Presentation of results :
• Ethic paper published to « Public Health Action » – June 2013
• Poster at IAS conference – July 2013• Oral presentation at World TB Union conference –
Paris, October 2013• Princeps paper published in « PLoS One » – January
2014 PK-genomics analysis still on-going
ANRS
Improving diagnosis of Tuberculosis in HIV-infected children in Asia & Africa with alternative specimen
collection methods (string test, nasopharyngeal aspirate) and Xpert MTB/RIF assay
Pediatric Asian African Network for Tuberculosis and HIV Research
PAANTHER 01 – ANRS 12229
420 HIV-infected children with suspicion of TB
4 countries: Burkina Faso, Cambodia, Cameroun, Vietnam
Principal objective: Develop a diagnostic algorithm to improve the diagnosis of TB in HIV-infected children
In Vietnam, HCMC: 3 hospitals : Pham Ngoc Thach hospital, Nhi Dong 1, Nhi Dong 2 Enrolment started in September 2012 108 children enrolled End of enrolment: June 2014End of the study: December 2014
ANRS
ANRS 12290 – STATISSystematic empirical vs. Test-guided Anti-TB
Treatment Impact in Severely immunosuppressed HIV-infected adults initiating ART with CD4 <100/mm3
Multi-countries, two-arm, unblinded, randomized, superiority trial: Ivory Coast, Cambodia, Cameroun, Uganda, Vietnam
Principal objective: To compare the 24-week risk of death and occurrence of invasive bacterial infection between 2 experimental strategies : continuous extensive TB screening (chest X-ray, Xpert, urine
LAM) during follow-up when the patient present symptoms systematic empirical TB treatment (2ERHZ/4RH) started 2 weeks
before ART initiation Specific objectives: Mortality, bacterial infections, loss-to-
follow-up, morbidity, tolerance of TB treatment, efficacy of ART, care consumption, cost-effectiveness of the strategies.
ANRS
ANRS 12290 – STATIS
1050 HIV-infected adults (CD4<100/mm3), naïve of ART
In Vietnam, Pham Ngoc Thach hospital, HCMC: 300 patients Process of submission to ERB MOH First patient enrolled September 2014 Inclusion time: 24 months End of follow-up: August 2017 First results: December 2017
Systematic empirical vs. Test-guided Anti-TB Treatment Impact in Severely immunosuppressed HIV-
infected adults initiating ART with CD4 <100/mm3
ANRS
W0 W 24 W48
1:1
TDF245mg qd + 3TC 300mg qd + RAL 400 mg bid
TDF245mg qd + 3TC 300mg qd + EFV 600 mg qd
RHZE 2mo followed by RH 4mo
460 patients• VIH-1• ART naïve• Tuberculosis• RIF containing regimen
Primary endpoint HIV RNA<250 copies/mL
ANRS 12300 – REFLATE TB 2Non-inferiority of TDF/3TC & Raltegravir 400 mg BID compared to TDF/3TC/Efavirenz in ART naïve HIV-
infected patients receiving Rifampicin
Phase 3 randomized trial in Brazil, France, Ivory Coast, Mozambic, Vietnam
ANRS
ANRS 12262 – FIBRHIVIET Study Pilot Study on clinical and virological
characteristics of HIV-HCV co-infected patients in Hai Phong
Main objective: To describe clinical and virological characteristics of HCV/HIV co-infected patients followed in Viet Tiep Hospital and potentially eligible for a HCV treatment
Specific objectives: To determine the proportion of patients with active HCV
infection To determine the genotype distribution of HCV infection To assess the severity of liver fibrosis To study factors associated with severity of liver fibrosis
Cross-sectional study in 111 HIV/HCV co-infected patients
Just finished clinical & biological activities Analysis ongoing
ANRS
ANRS 12299 – DRIVE-IN Study
Approved by ANRS in July 2013Primary Objective: To assess the efficacy of a combined preventative intervention
targeting PWID on the reduction of HIV incidence.Secondary objectives: To estimate the impact of the intervention on HCV
incidence, To estimate the overall HIV and drug-related morbidity and mortality, To identify the determinants of risk and harm reduction seeking behaviours,...)
Feasibility phase of an interventional project to reduce HIV incidence among people who inject
Drugs in Hai Phong, Viet Nam Primary objective: to evaluate the feasibility of implementing
an interventional cohort of PWID in Hai Phong by demonstrating that enrolment and follow-up of various hard-to-reach subgroups of PWID is feasible in the local context.
Sponsored by ANRS, funded by ANRS & NIDA 600 participants to the RDS study, then 250 participants
followed 6 months Agenda:
Submission to IRB HPMU next week First patient enrolled September 2014 Inclusion time: 6 months End of follow-up: May 2015
ANRS
Research priorities in Vietnam
Related to the National HIV/AIDS Research Agenda
Basic sciences, epidemiology, clinical trials, social science, …
At this moment:Interventions in most at risk populations, notably PWUDs (ex: “Test and Treat strategy”)
Co-infection with Tuberculosis (ex: “Phase III with rifabutin”)
Viral hepatitis C (ex: “Pilot project on HCV treatment in HIV-coinfected patients”)
But others topics possible
ANRS
Process to obtain ANRS funds for research project
2 call for grants/year: Deadline 15th of March & 15th of September Specific forms for submission (available on ANRS website,
in French) Submission in English OK 2 Principal Investigators: 1 from Vietnam and 1 from France Max: 36 months project
Review by an independent scientific Committee (CSS6): Meetings in June & December Answer 1 month later (positive in 25-30%)
If needed: Help from ANRS site coordinators (finding French partners, writing protocol, submission, …)
ANRS Cám ơn nhiều