Sarah Fidler

Last updated
Sarah Fidler
NationalityEnglish
CitizenshipUnited Kingdom
Alma mater King's College London (MBBS Medicine)
Imperial College London (PhD)
Known forProfessor in HIV Medicine testing new approaches towards curing HIV
Children3
Scientific career
Fields
Institutions Imperial College London
St. Mary's Hospital, London

Sarah Fidler FRCP is an immunologist, researcher and professor in HIV Medicine at Imperial College London and consultant physician in HIV for St Mary's Hospital, London. [1] [2]

Contents

Her clinical work involves looking after people who have just been infected with the human immunodeficiency virus (HIV), and testing new approaches towards curing HIV. [3]

Career and research

Fidler grew up in Hull, a fishing town in East Yorkshire, England. [4] Fidler first qualified as a doctor at King's College London in 1989 she saw that young people were dying of HIV. It wasn't for another six years, that life-saving antiretroviral treatment for HIV was made available and first rolled out in 1995. [3]

Fidler became a Fellow of the Royal College of Physicians in 1992 and undertook her PhD at Imperial College London from 1994 to 1998. [1] Fidler has stated that it was the passion of some of those living with HIV, whom she had the privilege to treat, that has driven her research career. [3] She has worked at the Department of Medicine at Imperial College London since 2016, which has been revealed as one of the top three UK institutions publishing work on HIV/AIDS research. [5]

'Kick and kill' approach

The speed of the research has been made possible because of the advocacy community that stands behind it.... In our most recent trial, no-one dropped out, which is practically unheard of.
It’s still a very stigmatising condition. People don’t feel comfortable with talking about it, as they might with diabetes or cancer. I think it motivates this collaboration. People still feel that they are somehow different and that’s what makes people join together, they relate to these other people who have the virus. They are a potent advocacy force.

Professor Sarah Fidler, The Guardian, 30 November 2018, [6]

Between 2015 and 2017, Fidler led a study testing the efficacy of the "kick and kill" strategy in HIV which aimed at waking up resting HIV cells out of their sleep so they can be identified and then eliminated. [6] [7]

The findings of this phase 2 trial, published in The Lancet in 2020, demonstrated that the approach was safe with participants adhering to the protocol and the approach "conferred no significant benefit compared with ART alone on measures of the HIV reservoir. Although this does not disprove the efficacy of the kick and kill strategy, for future trials enhancement of both kick and kill agents will be required." [8]

Bone marrow replacement and HIV remission

The first reported case of a patient, Timothy Ray Brown, with sustained remission from HIV-1 after ceasing treatment was known as "the Berlin patient". In 2019, some ten years after "the Berlin patient", a report of a second HIV-1 patient in remission was published in Nature . The research, funded by Wellcome and the Medical Research Council among others, and led by researchers at University College London and Imperial College London with partners at the University of Cambridge and the University of Oxford, evidenced that a second HIV-1 patient had indeed achieved sustained remission for 18 months following bone marrow replacement. [9]

Fidler questioned the feasibility of this invasive treatment being scaled up stating:

The report of a second case of HIV remission is of great interest but does not move the scientific field forward very significantly over the Berlin patient. Rather, it reinforces the science that this is rare but feasible.... The main important message from this report is that dCCR5 homozygous bone marrow donors should be specifically selected where possible for people living with HIV on ART (anti-retroviral therapy), who develop cancer and require this treatment. [10]

'Test and Treat' and HIV elimination

The United Nations (UN) initiative to help end the AIDS epidemic, "90-90-90" aims to get 90% of people with HIV knowing their HIV status, with 90% of these people on treatment, and 90% of those on treatment exhibiting viral suppression. [11]

Fidler is co-principal investigator of the HPTN 071 (PopART) study, testing the impact of a combination HIV prevention package that includes a universal HIV test and treat strategy. [4] Fidler stated that in 2017 that the HPTN071 (PopART) trials in Zambia and South Africa, where entire communities were offered voluntary HIV testing, and those testing positive were immediately referred for HIV treatment, had resulted in resulted in 90% of the population knowing their status, with 80% on treatment. The final statistic on those exhibiting viral suppression was not measured. [3]

The idea behind our study was if most people living with HIV know their HIV status and take treatment, the risk of passing the virus on to their partners and children will be greatly reduced. The results show that this approach was successful –we hope the findings may help to reduce the number of new HIV infections across the world.

Professor Sarah Fidler, study author.[ citation needed ]

The research team behind these trials was led by Fidler and Richard Hayes, Professor of Epidemiology and International Health at the London School of Hygiene & Tropical Medicine and was funded by the U.S. National Institutes of Health and the Bill and Melinda Gates Foundation among others.

Trials from 2013 to 2018 were conducted in 21 communities (of roughly 50,000 people in each) in Zambia and South Africa. This represents the largest ever HIV prevention trial yet, covering a total population of approximately 1 million people. [12]

The findings published in the New England Journal of Medicine in 2019 showed that offering entire communities voluntary HIV testing, and immediately referring those who test positive for HIV treatment, could make a significant difference in controlling new HIV infections in southern Africa. [12] New HIV infections were found to be 30% lower in communities where this intervention was introduced alongside offering other proven HIV prevention measures to those who tested negative, compared to communities that received standard care. [5] [13]

Speaking about the study's findings, Professor Hayes stated:

The primary results showed that the PopART universal testing-and-treatment intervention reduced the incidence of new infections – at population level – by about 20%.... At IAS 2019 [the biennial conference on HIV Science] the team reported the results of model projections showing that by the year 2030 new HIV infections each year will be 50-60% less if the PopART intervention is sustained. Costing results were also presented, showing that the annual cost of the service was $7 per person, and that the intervention was in the range regarded as cost-effective.These new findings show clearly that the PopART community-wide service for universal testing and treatment is feasible, acceptable and affordable. If sustained over time, this intervention has the potential to steeply reduce HIV incidence and contribute to global efforts to work towards HIV elimination by the year 2030. [13]

Selected publications

Personal life

Fidler has worked part-time throughout her twenty-year career in order to give her the opportunity to spend time with her family. [4]

Outside of work, Fidler has stated that she enjoys running, reading, loves music, travelling and spending time with her "three very patient and supportive grown-up children and [her] husband". [4]

See also

Related Research Articles

The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple drugs that act on different viral targets is known as highly active antiretroviral therapy (HAART). HAART decreases the patient's total burden of HIV, maintains function of the immune system, and prevents opportunistic infections that often lead to death. HAART also prevents the transmission of HIV between serodiscordant same-sex and opposite-sex partners so long as the HIV-positive partner maintains an undetectable viral load.

Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring.

<span class="mw-page-title-main">Nevirapine</span> Chemical compound

Nevirapine (NVP), sold under the brand name Viramune among others, is a medication used to treat and prevent HIV/AIDS, specifically HIV-1. It is generally recommended for use with other antiretroviral medications. It may be used to prevent mother to child spread during birth but is not recommended following other exposures. It is taken by mouth.

This is a list of AIDS-related topics, many of which were originally taken from the public domain U.S. Department of Health Glossary of HIV/AIDS-Related Terms, 4th Edition.

<span class="mw-page-title-main">Emtricitabine/tenofovir</span> Drug combination for HIV/AIDS prophylaxis and treatment

Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoproxil. For treatment, it must be used in combination with other antiretroviral medications. For prevention before exposure, in those who are at high risk, it is recommended along with safer sex practices. It does not cure HIV/AIDS. Emtricitabine/tenofovir is taken by mouth.

<span class="mw-page-title-main">Pre-exposure prophylaxis for HIV prevention</span> HIV prevention strategy using preventative medication for HIV-negative individuals

Pre-exposure prophylaxis for HIV prevention, commonly known as PrEP, is a form of pre-exposure prophylaxis to prevent HIV infection, the cause of HIV/AIDS.

<span class="mw-page-title-main">HIV Prevention Trials Network</span>

The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that brings together investigators, ethicists, community and other partners to develop and test the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. HPTN studies evaluate new HIV prevention interventions and strategies in populations and geographical regions that bear a disproportionate burden of infection. The HPTN is committed to the highest ethical standards for its clinical trials and recognizes the importance of community engagement in all phases of the research process.

<span class="mw-page-title-main">HIV disease–related drug reaction</span>

HIV disease–related drug reaction is an adverse drug reaction caused by drugs used for the treatment of HIV/AIDS.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

HPTN 052 is the name of a clinical trial conducted in nine countries which examined whether starting people living with HIV on antiretroviral therapy (ART) can reduce the chance that they will pass HIV on to their sexual partners who do not have HIV. The trial showed remarkable success in preventing HIV transmission and were so compelling that the study's Data and Safety Monitoring Board (DSMB) asked the research team to share the results with all study participants and offer ART to the control group before the study ended. As a result of the study there was increased consensus that treatment as prevention should be included as a public health strategy in lowering HIV infection. The trial was organized by the HIV Prevention Trials Network (HPTN) and its chief architect was Myron S. Cohen.

The Berlin patient is an anonymous person from Berlin, Germany, who was described in 1998 as exhibiting prolonged "post-treatment control" of HIV viral load after HIV treatments were interrupted.

<span class="mw-page-title-main">HIV/AIDS research</span> Field of immunology research

HIV/AIDS research includes all medical research that attempts to prevent, treat, or cure HIV/AIDS, as well as fundamental research about the nature of HIV as an infectious agent and AIDS as the disease caused by HIV.

<span class="mw-page-title-main">Cabotegravir</span> Medication for HIV/AIDS

Cabotegravir, sold under the brand name Vocabria among others, is a antiretroviral medication used for the treatment of HIV/AIDS. It is available in the form of tablets and as an intramuscular injection, as well as in an injectable combination with rilpivirine under the brand name Cabenuva.

Julio S. G. Montaner, is an Argentine-Canadian physician, professor and researcher. He is the director of the British Columbia Centre for Excellence in HIV/AIDS, the chair in AIDS Research and head of the Division of AIDS in the Faculty of Medicine at the University of British Columbia and the past-president of the International AIDS Society. He is also the director of the John Ruedy Immunodeficiency Clinic, and the Physician Program Director for HIV/AIDS PHC. He is known for his work on HAART, a role in the discovery of triple therapy as an effective treatment for HIV in the late 1990s, and a role in advocating the "Treatment as Prevention" Strategy in the mid-2000s, led by Myron Cohen of the HPTN 052 trial.

The Mississippi baby is a Mississippi girl who in 2013 was thought to have been cured of HIV. She had contracted HIV at birth from her HIV-positive mother. Thirty hours after the baby was born, she was treated with intense antiretroviral therapy. When the baby was about 18 months old, the mother did not bring the child in for scheduled examinations for the next five months. When the mother returned with the child, doctors expected to find high levels of HIV, but instead the HIV levels were undetectable. The Mississippi baby was thought to be the other person, after the "Berlin patient," to have been cured of HIV. As a result, the National Institutes of Health planned to conduct a worldwide study on aggressive antiretroviral treatment of newborn infants of mothers with HIV infections. It was thought that aggressive antiretroviral therapy on newborn infants might be a cure for HIV. On July 10, 2014, however, it was reported that the child was found to be infected with HIV.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. When taken correctly, ART is able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals.

HPTN 083 is a 2016 clinical trial which compares cabotegravir injections with oral use of Emtricitabine/tenofovir as pre-exposure prophylaxis ("PrEP") for prevention of HIV/AIDS.

Elizabeth Anne Bukusi FAAS is a research professor working within the field of obstetrics and gynaecology, and global health. Bukusi's main areas of research focus around sexually transmitted infections, women's health, reproductive health, and HIV care, prevention and treatment. Bukusi is the Chief Research Officer at the Kenya Medical Research Institute (KEMRI) and led a "landmark" study on the use of PrEP in Kenya.

The Swiss Statement, or the Swiss Consensus Statement, was an announcement published in January 2008 by the Swiss Federal Commission for AIDS/HIV outlining the conditions under which an HIV-positive individual could be considered functionally noncontagious—namely, adherence to antiretroviral therapy, a sufficiently low viral load, and a lack of any other sexually transmitted diseases. While lacking the backing of complete, fully randomized clinical studies, the Commission felt the contemporary evidence for non-contagiousness for people on antiretroviral treatment was nonetheless strong enough to warrant official publication.

References

  1. 1 2 ORCID. "Sarah Fidler (0000-0003-1676-7583)". orcid.org. Retrieved 2020-06-26.
  2. ↑ "Dr Sarah Fidler". www.imperial.nhs.uk. Retrieved 2020-06-26.
  3. 1 2 3 4 "Transforming HIV: Q&A with Professor Sarah Fidler | Imperial News | Imperial College London". Imperial News. Retrieved 2020-06-26.
  4. 1 2 3 4 "Sarah Fidler | The HIV Prevention Trials Network". www.hptn.org. Retrieved 2020-06-26.
  5. 1 2 "World AIDS Day – a year of advances in HIV research | Imperial News | Imperial College London". Imperial News. Retrieved 2020-06-26.
  6. 1 2 Flanagan, Jack (2018-11-30). "A cure for HIV is in sight as science chases the holy grail". The Guardian. ISSN   0261-3077 . Retrieved 2020-06-26.
  7. ↑ "Novel strategy to eradicate HIV infection tested in international trial – NIHR Imperial Biomedical Research Centre" . Retrieved 2020-06-26.
  8. 1 2 Fidler, Sarah; Stöhr, Wolfgang; Pace, Matt; Dorrell, Lucy; Lever, Andrew; Pett, Sarah; Loes, Sabine Kinloch-de; Fox, Julie; Clarke, Amanda; Nelson, Mark; Thornhill, John (2020-03-14). "Antiretroviral therapy alone versus antiretroviral therapy with a kick and kill approach, on measures of the HIV reservoir in participants with recent HIV infection (the RIVER trial): a phase 2, randomised trial". The Lancet. 395 (10227): 888–898. doi:10.1016/S0140-6736(19)32990-3. ISSN   0140-6736. PMID   32085823. S2CID   211166601.
  9. ↑ "HIV remission achieved in second patient | Imperial News | Imperial College London". Imperial News. Retrieved 2020-06-26.
  10. ↑ "expert reaction to HIV-1 remission in a second patient | Science Media Centre" . Retrieved 2020-06-26.
  11. ↑ "90-90-90: treatment for all". www.unaids.org. Retrieved 2020-06-26.
  12. 1 2 3 Hayes, Richard J.; Donnell, Deborah; Floyd, Sian; Mandla, Nomtha; Bwalya, Justin; Sabapathy, Kalpana; Yang, Blia; Phiri, Mwelwa; Schaap, Ab; Eshleman, Susan H.; Piwowar-Manning, Estelle (2019-07-18). "Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)". New England Journal of Medicine. 381 (3): 207–218. doi:10.1056/NEJMoa1814556. ISSN   0028-4793. PMC   6587177 . PMID   31314965.
  13. 1 2 "'Test and Treat' intervention could contribute to towards HIV elimination by the year 2030". LSHTM. Retrieved 2020-06-26.
  14. ↑ Kim, Sung-Hee; Gerver, Sarah; Fidler, Sarah; Ward, Helen (2014-08-24). "Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis". AIDS. 28 (13): 1945–1956. doi:10.1097/QAD.0000000000000316. ISSN   0269-9370. PMC   4162330 . PMID   24845154.
  15. ↑ Elliott, Tamara; Sanders, Eduard J; Doherty, Meg; Ndung'u, Thumbi; Cohen, Myron; Patel, Pragna; Cairns, Gus; Rutstein, Sarah E; Ananworanich, Jintanat; Brown, Colin; Fidler, Sarah (2019-12-18). "Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review". Journal of the International AIDS Society. 22 (12): e25419. doi:10.1002/jia2.25419. ISSN   1758-2652. PMC   6918508 . PMID   31850686.
  16. ↑ Bwalya, Chiti; Simwinga, Musonda; Hensen, Bernadette; Gwanu, Lwiindi; Hang’andu, Able; Mulubwa, Chama; Phiri, Mwelwa; Hayes, Richard; Fidler, Sarah; Mwinga, Alwyn; Ayles, Helen (2020-06-11). "Social response to the delivery of HIV self-testing in households: experiences from four Zambian HPTN 071 (PopART) urban communities". AIDS Research and Therapy. 17 (1): 32. doi: 10.1186/s12981-020-00287-y . ISSN   1742-6405. PMC   7288417 . PMID   32527261.
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