Fighting Ebola with HIV drugs gets big shot in the arm

A combination of three HIV drugs does a remarkably good job fighting Ebola in the laboratory, according to research presented May 1 at the Canadian Association for HIV Research.

If the drugs work in humans – and that’s a big if – it would be a game-changer in the fight against Ebola. HIV drugs are relatively inexpensive and available in West Africa, where more than 10,000 people have died in the ongoing Ebola outbreak.

“If it works out, we’ll be doing somersaults – if I knew how to do one – down the hallways,” said one of the researchers, Dr. Donald Branch, an associate professor in the department of laboratory medicine and pathobiology at the University of Toronto.

The researchers decided to undertake the experiment after they read a CNN story last fall about Dr. Gorbee Logan, a Liberian physician who said he treated 15 Ebola patients with lamivudine and 13 survived.

The University of Toronto tried lamivudine, AZT, and tenofovir in the lab. Each was effective against Ebola individually, but the combination of the three worked the best, reducing the virus’ rate of replication by 88%.

“When I saw the results, I asked one of my colleagues to take a picture, because I thought, ‘We just made history’,” said Stephen McCarthy, one of Branch’s doctoral students.

But the World Health Organization and the National Institutes of Health aren’t nearly as enthusiastic.

First, the University of Toronto researchers didn’t use the actual Ebola virus, but a modified version that won’t infect humans. They hope to gain access to a Biosafety Level 4 lab, where work with the actual virus is allowed.

“These studies are interesting, but still rather preliminary,” said Dr. Anthony Fauci, director of the National Institutes for Allergy and Infectious Diseases at the National Institutes of Health. “It would be important to repeat them with live Ebola virus under the appropriate BSL-4 conditions.”

After reading CNN’s story about Logan, the NIH researchers experimented with one of the three drugs in the Canadian study, lamivudine, and found it didn’t work in their lab, confirming a study they’d done before.

The Canadian doctors questioned the NIH’s methods, saying their scientists didn’t allow enough time for the virus to be exposed to the drug.

Tarik Jasarevic, a spokesman for the World Health Organization, called the virus used at the University of Toronto “artificial” and said there is “little correlation” between their results and the results achieved when using a live virus.

In November, the University of Toronto researchers sent their results about HIV drugs to Dr. Martin Friede at the World Health Organization. While they say they never received a direct response, the next day Friede stated at a press conference that data showed lamivudine “has no antiviral activity against [Ebola virus disease] and should therefore not be administered for the treatment of Ebola.”

But not all doctors in Liberia are listening. Dr. Benedict Kolee said he gave lamivudine to three Ebola patients and all three lived, while without the drug most patients died.

Kolee said he himself took it after he treated a man with Ebola without wearing protective gear. The man died of Ebola two days later. Kolee was not infected.

A friend of his, another physician, became infected after treating the same patient. Kolee says he tried to sneak lamivudine into the hospital for his friend, but the doctor at the hospital stopped him, saying the drug wasn’t allowed.

“He died a few hours later, and by the grace of God I’m still alive because I took lamivudine prophylaxis,” he said. “If I had an Ebola case today, I would give him lamivudine.”

The World Health Organization is studying several drugs – but no HIV drugs – in clinical trials to see if they help Ebola patients. Most of them are not generics.

In the recent study, two out of the three HIV drugs are generics, and the third, tenofovir, is expected to be available as a generic at the end of 2017. Generic drugs typically are not as lucrative for manufacturers as nongeneric drugs.

“Perhaps the best approach to drug development would be to look at all available alternatives, and not just ones that have huge market potential,” said Eric Campbell, a professor of medicine at Harvard Medical School and director of research at the Mongan Institute for Health Policy.