Global Cohort Collaboration
In May 2013, CIPHER convened a Paediatric HIV Cohort Investigator Consultation (see meeting report) with investigators from major paediatric HIV cohorts worldwide. This meeting defined a research agenda of priority knowledge gaps in paediatric HIV that can be effectively addressed by cohort collaboration, and resulted in agreement by the investigators present to collaborate on major data-sharing projects addressing two of those gaps:
- The durability of first-line antiretroviral treatment (ART) in children in resource-limited settings
- The global epidemiology of adolescents living with HIV since birth.
These two projects aim to fill research gaps and support evidence-informed clinical, policy and programmatic decision making to optimize care and treatment of children and adolescents.
CIPHER is providing a grant of US$500,000 to fund these two projects, the first to include such a broad range of participating paediatric cohorts. Results will be published in peer-reviewed journals, under group authorship as “CIPHER Cohort Collaboration”.
Time on first-line ART in children
Data on the durability of ART regimens is critical to inform clinicians, public health policy and programme planning, particularly in HIV-infected children under five years old who, according to the new 2013 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection, have been recommended for initiation of immediate therapy and are likely to need life-long treatment. However, data on the probability of switch to second-line in children are limited, and definitions of what constitutes “second-line” treatment vary.
The CIPHER Cohort Collaboration project is aimed at: estimating the incidence of treatment switch to second-line ART and associated factors; describing the durability of first-line regimens; and describing the most commonly used first- and second-line regimens.
Global epidemiology of HIV in perinatally infected adolescents
As the HIV epidemic matures, there is a growing population of adolescents living with HIV. From 2005 to 2012, this particularly vulnerable group has seen a 50% increase in AIDS-related mortality compared with a decrease of 30% in the global population of people living with HIV. In order to ensure optimal health outcomes, there is a global need to better understand the characteristics of these adolescents and how to ensure that they make the transition from paediatric to adult care. This project will describe the global epidemiology of perinatally HIV-infected adolescents and compare outcomes across regions.
Data centres on three continents
Three data centres are collaborating on the data collection and analysis for the project. The principal investigator for the project is Dr Mary-Ann Davies (Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa), in partnership with the lead investigators, Dr Ali Judd (Medical Research Council Clinical Trials Unit at University College London, UK) and Dr George Seage III (Paediatric HIV/AIDS Cohort Study Data and Operations Center, Harvard School of Public Health, USA). Findings of the studies will be published jointly under the CIPHER Cohort Collaboration.
Built into the grant from CIPHER is a capacity-building scholarship for a scholar from the University of Cape Town to participate in the statistical analysis that will be done at the Harvard School of Public Health.
- Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI)
- Caribbean, Central and South America Network for HIV Research (CCASAnet)
- East African International Databases to Evaluate AIDS (EA-IeDEA)
- The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) including PMTCT and Eastern European cohorts
- Identifying Optimal Models for Care in Africa (Optimal Models ICAP)
- International Epidemiologic Database to Evaluate AIDS Central Africa (CA-IeDEA)
- International Epidemiologic Database to Evaluate AIDS Southern Africa (IeDEA-SA)
- International Epidemiologic Database to Evaluate AIDS West Africa Collaboration (WADA and pWADA)
- Médecins Sans Frontières Pediatric Cohorts (MSF)
- Pediatric HIV/AIDS Cohort Study: Adolescent Master Protocol (PHACS AMP) and Surveillance Monitoring for ART Toxicities Study (PHACS SMARTT)
- Pediatric Late Outcomes Protocol (PACTG/IMPAACT 219/219c) and A Prospective Surveillance Study of Long-term Outcomes in HIV-infected Infants, Children and Adolescents (IMPAACT P1074)
- TREAT Asia Pediatric HIV Observational Database (TApHOD-IeDEA).