Dr. Fletcher collaborates on study on HIV treatment

Courtney Fletcher, Pharm.D., dean of the UNMC College of Pharmacy, is part of an international collaboration to have explored the mystery of why HIV now can be successfully treated by antiretroviral therapies, but not yet completely wiped out.

Thanks to the team, led by investigators from the University of Minnesota, and stretching as far as Uganda, that is no longer as much of a mystery.

Dr. Fletcher and the team had previously found that HIV “hides out” in lymphoid tissues, avoiding antiretroviral therapy. HIV still is able to replicate in these reservoirs, despite being driven to undetectable levels in blood.

But now, the team has published its latest discoveries in an October 2017 study in Nature Medicine.

Dr. Fletcher said the study had three takeaway findings:

• Ninety-nine percent of HIV-infected cells are found in lymphoid tissue such as lymph nodes, spleen, and the gastrointestinal tract;
• HIV-infected cells in these reservoir tissues were making viral particles even during anti-HIV therapy;
• The concentrations of antiretroviral drugs in these tissues were much lower than in the blood, and apparently suboptimal (ineffective).

The antiretroviral drugs that were keeping the virus at bay weren’t effectively reaching these “hideout” areas in order to fully knock out the virus, and these hideout areas, or reservoirs, are where most of the virus is. Having identified the problem makes a solution possible, Dr. Fletcher said.

“This finding identifies a key objective to achieve the goal of stopping virus production,” Dr. Fletcher said. “We need better drugs that get into the lymphoid tissue reservoir.”

Enhancing drug delivery is a focus of the Center for Drug Delivery and Nanomedicine at UNMC, which includes scientists from the Colleges of Pharmacy and Medicine. Dr. Fletcher is among a select few deans of pharmacy nationwide to maintain an active research lab. He recently announced that after a decade leading UNMC’s College of Pharmacy, he is stepping down as dean to further concentrate on teaching and research.