In a groundbreaking initiative, a new trial named REVIVE is set to test the efficacy of a low-cost antibiotic in reducing mortality rates among 8,000 patients with advanced HIV undergoing or restarting anti-retroviral therapy (ART).
The trial is funded by the Bill & Melinda Gates Foundation and will be conducted by a pan-African network of investigators.
It is co-led by researchers from the University of Cape Town (UCT) and the Population Health Research Institute (PHRI) in Canada.
The objective and aim of the REVIVE trial is to assess whether the antibiotic azithromycin, administered once daily over a four-week period, can effectively reduce mortality rates among adults grappling with advanced HIV.
Why is this trial so important?
Sean Wasserman, co-principal investigator of the study and affiliated with St George’s, University of London, emphasised the potential significance of this trial, stating, “If azithromycin is shown to be effective, it will modify the standard of care for patients with advanced HIV in Africa.”
Wasserman underscored the broader significance of the REVIVE trial, stating, “The REVIVE trial aims to identify an effective and implementable public health strategy to reduce the unacceptably high early mortality experienced by people with advanced HIV and will establish a pan-African network for future research to improve care for this population.”
Graeme Meintjes, chair of the trial steering committee and professor of Infectious Diseases at UCT, highlighted the role of bacterial infections in contributing to high mortality rates among HIV patients.
He expressed optimism that broader antibiotic prophylaxis, such as the administration of azithromycin, could potentially mitigate this problem and save lives.
Despite the increased availability of ART in Africa, many individuals initiate or resume treatment only after their HIV has progressed to an advanced stage. A previous trial demonstrated promising results, showing that enhanced preventative treatment, including a short course of azithromycin, reduced mortality by 27% at 24 weeks among patients with advanced HIV in Africa.
Prioritising research
The World Health Organization has prioritised research on approaches to antibiotic therapy for patients with advanced HIV.
This is as HIV-related illnesses continue to claim a staggering 630,000 lives annually, with a significant portion of these fatalities occurring in sub-Saharan Africa.
John Eikelboom, co-PI of the study and a senior scientist at PHRI, stressed the urgency of addressing this issue, noting, “With HIV persisting as one of the top five causes of mortality in Africa, addressing this issue remains an urgent international priority.”
The REVIVE trial will be conducted across more than 100 sites in various African countries, including Botswana, Ethiopia, Ghana, Ivory Coast, Malawi, Nigeria, Republic of the Congo, Rwanda, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia, with additional countries expected to join. Already, over 330 patients have been enrolled at six sites spanning three countries.
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