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SPOTLIGHT: Faculty Scholar works domestically and globally toward a cure for HIV

George Kyei, MBChB, PhD

Associate Professor, Departments of Medicine and Molecular Microbiology
Washington University School of Medicine
Senior Research Fellow, Noguchi Memorial Institute for Medical Research, University of Ghana
Director of Research, University of Ghana Medical Center
Institute for Public Health Faculty Scholar and collaborator with the Global Health Center and the Center for Dissemination and Implementation

George Kyei is a physician scientist who is board-certified in internal medicine and infectious diseases. His research centers on finding a cure for HIV. He is the principal investigator of the HIV Cure Research Infrastructure Study, based at the University of Ghana, which trains African scientists in HIV research and treatment. While also serving as the director of research at the University of Ghana Medical Center, and as associate professor at Washington University in St. Louis, he operates labs at both WashU and in Ghana and shares his time between the two. To illuminate his work in this Faculty Scholar Spotlight, we recently spoke with Kyei about his vital research.

Q: What is the latest update on your research and, can you share any significant discoveries?  

My research focuses on how to find long-term remission or cure for HIV. Currently, we have excellent treatments for HIV but they do not provide a cure. If patients stop taking their medications for any reason, the virus comes back within a short time period. This is because the virus can integrate into and hide in the reservoir cells of the patient (CD4 T cells, macrophages, etc). My research at WUSTL and the University of Ghana seeks to understand how the virus survives in patients despite strong therapies and immune pressure. Over the past few years, we have identified three important cellular factors and small molecules that control HIV multiplication in HIV cellular reservoirs such as CD4+ T cells and macrophages.

Since about 70% of HIV patients live in Africa, and to help increase HIV cure research capacity in Africa, I extended my research to Ghana in 2018. Important questions such as how co-infections like malaria, helminths and tuberculosis affect the HIV viral reservoir can only be answered in Africa. In addition, cure research must consider genetic and immune differences between African patients and those in the U.S. or Europe, and all the unique types of HIV in Africa that do not exist anywhere else. A systematic review we are conducting shows that only about 5% of HIV cure studies include African patients or investigators, which is woefully inadequate. The fear is that if we don’t involve Africa in cure research at this stage, we may find a cure that may not be effective for African patients.

With a grant from the European Developing Countries Clinical Trials Partnership and tremendous support from WashU’s Division of Internal Medicine, I set up the HIV Cure Research Infrastructure Study at the University of Ghana. We follow 400 patients on a regular basis to measure their immune status, viral load and other parameters. The study screens 150 compounds and African herbal extracts for their ability to remove the HIV reservoir and we are examining how African patients think about HIV cure and cure research. Our first publication on this shows that, in terms of risk tolerance and what they may consider as a cure, there are significant differences between how patients in Ghana and those in the U.S. think about cure research.

Q: What is the current rate of HIV infection in Ghana and what is the most effective intervention currently in place?

About 350,000 people live with HIV in Ghana, which translates to a prevalence of 1.7-2% of the population, with ART coverage above 65%. The main effective intervention is ART, which patients have now come to accept. Dolutegravir, one of the most effective medicines was recently introduced in Ghana. With reports of metabolic effects like high blood sugar and obesity associated with this drug, we will be monitoring to see how Ghanaian patients tolerate its introduction.

Q: We have heard the assertion that ‘what we’re doing globally, can be done here’. Are there specific components of your work in Ghana that can be implemented effectively in the St. Louis region?

In Ghana, primary physicians and trained nurses administer and supervise ART. This helps to reduce patient’s travel distance.  Plus, integration into the regular clinic also reduces stigma for patients. Probably such ‘decentralization’ could work in outlying counties and rural MO to help patients engage in care. Our team plans to study how patients in Ghana compare to those in Saint Louis in terms of their views on HIV cure, what they will consider as a cure (complete viral elimination versus long-term remission), what risks they are willing to take to get a cure, and what types of cures they will endorse.

Q: On a personal note, how do you juggle your incredible workload, research, teaching, et al, between St. Louis/WashU and University of Ghana? (We could all use your energy level!)

Juggling between the two places has been relatively stress free mainly because of the incredible support from the leadership of Internal Medicine (Dr. Fraser) and Infectious Diseases (Drs Powderly, Goldberg and Philips). Other members of the Division have been supportive, such as Dr. Gary Weil, who pointed me to the grant that enabled me to set up the research program in Ghana. As WashU seeks to have a stronger global footprint, the University should look into supporting more of this type of joint appointment model for global scholars who desire to spend significant amount of time in their home countries. Being in Ghana where I am familiar with the culture and know a lot of people enables me to make more impact, but also facilitate entry for other WUSTL faculty members who want to work in Ghana. It is a win-win situation as it helps reverse the brain drain from Africa while helping advance the university’s global health agenda.

Q: What advice would you give infectious disease practitioners, students and researchers about the current state of HIV and the importance of engaging in work to eradicate this particular disease?

While tremendous progress has been made in HIV treatment, significant problems remain. Even in the U.S., up to 30% or more of patients who know they have HIV are not in care, so, the issue of access to care is important in both the U.S. and Africa. Research into the acceptability of ART, pre-exposure prophylaxis, long-acting ART and cure are all areas that need urgent investigation. For Africa, we also need capacity in the basic science of HIV and cure research, and in implementation science research training.