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Cluver LD, Zhou S, Orkin M, Rudgard W, Meinck F, Langwenya N, Vicari M, Edun O, Sherr L, Toska E. Impacts of intimate partner violence and sexual abuse on antiretroviral adherence among adolescents living with HIV in South Africa. AIDS 2023; 37:503-511. [PMID: 36695360 PMCID: PMC9894135 DOI: 10.1097/qad.0000000000003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We are failing to reach 95-95-95 for adolescents living with HIV (ALHIV). Sexual abuse and intimate partner violence (IPV) may impact antiretroviral therapy (ART) adherence, with high rates of 17.4 and 29.7%, respectively, across the southern sub-Saharan African region. However, evidence on their associations with adolescent ART adherence remains limited, with only three cross-sectional studies globally. DESIGN A prospective cohort of ALHIV (sample N = 980, 55% female individuals, baseline mean age 13.6 years) were recruited from 53 health facilities in South Africa's Eastern Cape Province and responded to a structured questionnaire at 18-month and 36-month follow-up (2015-2016, 2017-2018). METHODS A repeated-measures random effects model assessed multivariable associations of self-reported sexual abuse and IPV with past-week ART adherence, controlling for individual, socioeconomic, and HIV-related factors. Past-week adherence was defined based on currently taking ART and not having missed any doses in the past 7 days (including weekends). We further fitted a moderation model by sex. RESULTS Fifty-one percent of adolescents reported consistent ART adherence at both time points. Exposure to IPV was associated with lower odds of self-reported ART adherence (aOR 0.39, 95% CI 0.21-0.72, P = 0.003), as was sexual abuse (aOR 0.54, 95% CI 0.29-0.99, P = 0.048). The marginal predicted probability of ART adherence for adolescents with no exposure to either IPV or sexual abuse was 72% (95% CI 70-74%) compared with 38% (95% CI 20-56%) for adolescents with exposure to both IPV and sexual abuse. Moderation results showed similar associations between sexual violence and ART adherence by sex. CONCLUSION Sexual violence prevention and postviolence care may be essential components of supporting adolescent ART adherence. Integration of HIV and violence prevention services will require accessible services and simple referral systems.
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Affiliation(s)
- Lucie D. Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health and Centre for Social Science Research
| | - Siyanai Zhou
- Centre for Social Sciences Research, Faculty of Humanities
- Division of Socio-Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Mark Orkin
- Wits/Medical Research Council Development Pathways to Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - William Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Scotland, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg
- North-West University, Optentia Research Focus Area, Vanderbijlpark, South Africa
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Sciences Research, Faculty of Humanities
| | | | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Sciences Research, Faculty of Humanities
- Faculty of Humanities, Department of Sociology, University of Cape Town, Cape Town, South Africa
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O'Rourke J, Townsend CL, Milanzi E, Collins IJ, Castro H, Judd A, Vicari M, Jesson J, Leroy V, Penazzato M, Renaud F. Effectiveness and safety of tenofovir alafenamide in children and adolescents living with HIV: a systematic review. J Int AIDS Soc 2023; 26:e26037. [PMID: 36823283 PMCID: PMC9950035 DOI: 10.1002/jia2.26037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/31/2022] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Tenofovir alafenamide (TAF) is approved for paediatric use in fixed-dose combination tablets, but efficacy and safety data in children are limited. We conducted a systematic review on the efficacy/effectiveness and safety of TAF in infants, children and adolescents living with HIV. METHODS We searched MEDLINE, Embase, the Cochrane Library, clinical trial registries, reference lists and relevant conferences to identify literature published January 2009-March 2021. We included clinical trials and observational studies assessing the efficacy/effectiveness or safety of TAF through ≥6 months of treatment in participants aged 0-19 years. RESULTS AND DISCUSSION Overall 3626 abstracts and 371 full papers were screened. Four single-arm, innovator-funded trials (341 participants) and a pooled analysis of those trials were identified. All four trials included treatment-experienced and virally suppressed children or adolescents. One trial also included treatment-naïve adolescents with baseline viral load >1000 copies/ml. The risk of bias was rated as low in one study and unclear in the other three owing to missing data on study design (all conference presentations). At 48 weeks, 92% (46/50) of treatment-naïve participants were virally suppressed (one trial). Among treatment-experienced participants with viral load at 48 weeks, 214 of 224 participants were virally suppressed. Across the studies, one grade 3/4 adverse event was considered drug-related (intermediate uveitis). There were three discontinuations for adverse events (grade 2 anxiety and insomnia, grade 1 iridocyclitis [drug-related] and grade 1 pulmonary tuberculosis [unrelated to treatment]). One accidental death occurred across the four studies. In the pooled analysis of 223 participants, the median change in bone mineral density z-score (height- and age-adjusted) from baseline to 48 weeks was -0.12 (interquartile range [IQR] -0.46, 0.17) to 0.05 (IQR not reported) for spine, and -0.09 (IQR -0.33, 0.07) to 0.09 (IQR not reported) for total body less head. Weight-for-age z-scores increased by 0.25 from baseline to 48 weeks. CONCLUSIONS Four single-arm trials were identified in this systematic review, with initial evidence suggesting good viral suppression and no obvious safety concerns in children and adolescents on TAF-containing regimens over 24-48 weeks. However, further comparative and longer-term safety data are needed in children and adolescents, including on weight and metabolic changes.
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Affiliation(s)
- John O'Rourke
- Consultants to the World Health OrganizationGenevaSwitzerland
| | - Claire L. Townsend
- Consultants to the World Health OrganizationGenevaSwitzerland
- International AIDS SocietyGenevaSwitzerland
| | - Edith Milanzi
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | | | - Hannah Castro
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | - Ali Judd
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | | | - Julie Jesson
- Centre for Epidemiology and Research in POPulation Health (CERPOP)Inserm, Université de ToulouseUniversité Paul SabatierToulouseFrance
| | - Valériane Leroy
- Centre for Epidemiology and Research in POPulation Health (CERPOP)Inserm, Université de ToulouseUniversité Paul SabatierToulouseFrance
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Townsend CL, O'Rourke J, Milanzi E, Collins IJ, Judd A, Castro H, Vicari M, Jesson J, Leroy V, Renaud F, Penazzato M. Effectiveness and safety of dolutegravir and raltegravir for treating children and adolescents living with HIV: a systematic review. J Int AIDS Soc 2022; 25:e25970. [PMID: 36377082 PMCID: PMC9663860 DOI: 10.1002/jia2.25970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Globally about 1.7 million children were living with HIV in 2020. Two integrase strand transfer inhibitors, dolutegravir and raltegravir, are increasingly used in children. We conducted a systematic review to assess the effectiveness and safety of dolutegravir and raltegravir in children and adolescents living with HIV, aged 0-19 years. METHODS Sources included MEDLINE, Embase, the Cochrane Library, clinical trial registries, abstracts from key conferences and reference list searching. Observational studies and clinical trials published January 2009-March 2021 were eligible. Outcomes included efficacy/effectiveness (CD4 counts and viral load) and/or safety outcomes (mortality, grade 3/4 adverse events and treatment discontinuation) through 6 months or more post-treatment initiation. Risk of bias was assessed using previously published tools appropriate for the study design. Narrative syntheses were conducted. RESULTS AND DISCUSSION In total, 3626 abstracts and 371 papers were screened. Eleven studies, including 2330 children/adolescents, reported data on dolutegravir: one randomized controlled trial (RCT; low risk of bias), one single-arm trial (unclear risk of bias) and nine cohort studies (three low risk of bias, two unclear risk and four high risk). Ten studies, including 649 children/adolescents receiving raltegravir, were identified: one RCT (low risk of bias), one single-arm trial (low risk of bias) and eight cohort studies (four low risk of bias, three unclear risk and one high risk). Viral suppression levels in children/adolescents at 12 months were high (>70%) in most studies assessing dolutegravir (mostly second- or subsequent-line, or mixed treatment lines), and varied from 42% (5/12) to 83% (44/53) at 12 months in studies assessing raltegravir (mostly second- or subsequent-line). Across all studies assessing dolutegravir or raltegravir, grade 3/4 adverse events (clinical and/or laboratory) were reported in 0-50% of subjects, few resulted in discontinuation, few were drug related and no deaths were attributed to either drug. CONCLUSIONS These reassuring findings suggest that dolutegravir and raltegravir are effective and safe as preferred regimens in children and adolescents living with HIV. With the rollout of dolutegravir in paediatric populations already underway, it is critical that data are collected on safety and effectiveness in infants, children and adolescents, including on longer-term outcomes, such as weight and metabolic changes.
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Affiliation(s)
| | - John O'Rourke
- Consultants to the World Health OrganizationGenevaSwitzerland
| | - Edith Milanzi
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | | | - Ali Judd
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | - Hannah Castro
- MRC Clinical Trials Unit at UCLUniversity College LondonLondonUK
| | | | - Julie Jesson
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de ToulouseUniversité Paul SabatierToulouseFrance
| | - Valériane Leroy
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de ToulouseUniversité Paul SabatierToulouseFrance
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Slogrove AL, Burmen B, Davies MA, Edmonds A, Abrams EJ, Chadwick EG, Goetghebuer T, Mofenson LM, Paul ME, Thorne C, Williams PL, Vicari M, Powis KM. Standardized Definitions of In Utero Human Immunodeficiency Virus and Antiretroviral Drug Exposure Among Children. Clin Infect Dis 2022; 75:347-355. [PMID: 35181789 PMCID: PMC9410726 DOI: 10.1093/cid/ciab974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
In countries with high human immunodeficiency virus (HIV) prevalence, up to 30% of pregnant women are living with HIV, with fetal exposure to both HIV and antiretroviral therapy during pregnancy. In addition, pregnant women without HIV but at high risk of HIV acquisition are increasingly receiving HIV preexposure antiretroviral prophylaxis (PrEP). Investments are being made to establish and follow cohorts of children to evaluate the long-term effects of in utero HIV and antiretroviral exposure. Agreement on a key set of definitions for relevant exposures and outcomes is important both for interpreting individual study results and for comparisons across cohorts. Harmonized definitions of in utero HIV and antiretroviral drug (maternal treatment or PrEP) exposure will also facilitate improved classification of these exposures in future observational studies and clinical trials. The proposed definitions offer a uniform approach to facilitate the consistent description and estimation of effects of HIV and antiretroviral exposures on key child health outcomes.
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Affiliation(s)
- Amy L Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Worcester, South Africa
| | - Barbara Burmen
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Mary Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University and Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Ellen G Chadwick
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tessa Goetghebuer
- Department of Pediatrics, CHU St Pierre and Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Lynne M Mofenson
- Research Program, Elizabeth Glaser Pediatric AIDS Foundation, Washington D.C., USA
| | - Mary E Paul
- Department of Pediatrics Immunology, Allergy, and Retrovirology, Baylor College of Medicine, Houston, Texas, USA
| | - Claire Thorne
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Paige L Williams
- Department of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Kathleen M Powis
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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Renaud F, Mofenson LM, Bakker C, Dolk H, Leroy V, Namiba A, Sahin L, Shapiro R, Slogrove A, Thorne C, Vicari M, Low-Beer D, Doherty M. Surveillance of ARV safety in pregnancy and breastfeeding: towards a new framework. J Int AIDS Soc 2022; 25 Suppl 2:e25922. [PMID: 35851994 PMCID: PMC9294858 DOI: 10.1002/jia2.25922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction As new antiretrovirals (ARVs), including long‐acting ARVs for treatment and prevention, are approved and introduced, surveillance during pregnancy must become the safety net for evaluating birth outcomes, especially those that are rare and require large numbers of observations. Historically, drug pharmacovigilance in pregnancy has been limited and fragmented between different data sources, resulting in inadequate data to assess risk. The International Maternal Pediatric Adolescent AIDS Clinical Trials Network and World Health Organization convened a Workshop which reviewed strengths and weaknesses of existing programs and discussed an improved framework to integrate existing safety data sources and promote harmonization and digitalization. Discussion This paper highlights that although robust sources of safety data and surveillance programs exist, key challenges remain, including unknown denominators, reporting bias, under‐reporting (e.g. in voluntary registries), few data sources from resource‐limited settings (most are in North America and Europe), incomplete or inaccurate data (e.g. within routine medical records). However, recent experiences (e.g. with safety signals) and current innovations (e.g. electronic record use in resource‐limited settings and defining adverse outcomes) provide momentum and building blocks for a new framework for active surveillance of ARV safety in pregnancy. A public health approach should be taken using data from existing sources, including registries of pregnancy ARV exposure and birth defects; observational surveillance and cohort studies; clinical trials; and real‐world databases. Key facilitators are harmonization and standardization of outcomes, sharing of materials and tools, and data linkages between programs. Other key facilitators include the development of guidance to estimate sample size and duration of surveillance, ensuring strategic geographic diversity, bringing partners together to share information and engaging the community of women living with HIV. Conclusions Looking ahead, critical steps to safely introduce new ARVs include (1) adopting harmonized standards for measuring adverse maternal, birth and infant outcomes; (2) establishing surveillance centres of excellence in areas with high HIV prevalence with harmonized data collection and optimized electronic health records linking maternal/infant data; and (3) creating targets and evaluation goals for reporting progress on implementation and quality of surveillance in pregnancy. The platform will be leveraged to ensure that appropriate contributions and strategic actions by relevant stakeholders are implemented.
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Affiliation(s)
- Françoise Renaud
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Lynne M Mofenson
- Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Charlotte Bakker
- Seconded National Expert Translational Sciences Office Scientific Evidence Generation Department, European Medicines Agency, Amsterdam, The Netherlands
| | - Helen Dolk
- EUROmediCAT, Institute for Nursing and Health Research, Ulster University, Jordanstown, United Kingdom
| | - Valeriane Leroy
- Centre d'Epidémiologie et Recherche en Santé des POPulations (CERPOP), Inserm, Université de Toulouse Paul Sabatier, Toulouse, France
| | | | - Leyla Sahin
- Division of Pediatrics and Maternal Health, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Amy Slogrove
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Worcester, South Africa
| | - Claire Thorne
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Marissa Vicari
- HIV Programmes and Advocacy Department, International AIDS Society, Geneva, Switzerland
| | - Daniel Low-Beer
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
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Penazzato M, Lockman S, Colbers A, Renaud F, Calmy A, Clayden P, Vicari M, Mahaka IC, Zech JM, Irvine C, Abrams EJ. Accelerating investigation of new HIV drugs in pregnancy: advancing the research agenda from theory to action. J Int AIDS Soc 2022; 25 Suppl 2:e25912. [PMID: 35851834 PMCID: PMC9294865 DOI: 10.1002/jia2.25912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Historical approaches to clinical development of novel therapeutics for treatment and prevention of HIV have led to unacceptable delays in the generation of data to support optimal antiretroviral drug use in pregnancy. Over the last 5 years, multiple stakeholders have voiced their concerns around the exclusion of pregnant women from drug trials, and some progress has been made to consolidate principles and forge consensus. Building on ongoing efforts, the World Health Organization (WHO) and the International Maternal Paediatric Adolescent AIDS Clinical Trials Network (IMPAACT) convened a technical consultation designed to move the discussion from theory to practice. Discussion Accelerating the inclusion of pregnant women in pre‐licensure clinical trials, with a goal to have pharmacokinetics (PK) and preliminary safety data for all new HIV agents in pregnancy available at the time of drug approval, requires: (1) performing non‐clinical developmental and reproductive toxicology studies early in drug development for all new HIV agents; (2) recognizing and acting on the central role of women of childbearing potential affected by HIV through the research being conducted and the dissemination of associated results; (3) enrolling pregnant women in studies to specifically determine pregnancy PK and preliminary safety, as soon as late non‐clinical studies are completed with no negative signals, for all new HIV agents that have demonstrated preliminary evidence of safety and efficacy from phase 2 trials; (4) investigating adverse pregnancy and birth outcomes through dedicated pregnancy safety studies for all new priority HIV agents; and (5) expanding active surveillance of drug safety in pregnancy for rare events, such as birth defects. Strategic actions to pursue include developing tools and resources to support designing and implementing studies among pregnant and breastfeeding women, identifying and promoting modifications of the regulatory framework that are supportive of systematic ethical investigation of new drugs in pregnancy, coordinating surveillance efforts, mobilizing key stakeholders and promoting transparency and accountability for all involved. Conclusions With more than 19 million women living with HIV worldwide, ensuring greater inclusion of pregnant women in research on novel therapeutics is a priority to support drug optimization and effective introduction of innovations for treatment and prevention of HIV.
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Affiliation(s)
- Martina Penazzato
- Department of Global HIVHepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Shahin Lockman
- Brigham and Women's HospitalHarvard TH Chan School of Public HealthBostonMassachusettsUSA
| | - Angela Colbers
- Department of PharmacyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenNetherlands
| | - Françoise Renaud
- Department of Global HIVHepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Alexandra Calmy
- HIV/AIDS UnitDivision of Infectious DiseasesGeneva University HospitalsGenevaSwitzerland
| | | | - Marissa Vicari
- HIV Programmes and Advocacy DepartmentInternational AIDS SocietyGenevaSwitzerland
| | | | - Jennifer M. Zech
- ICAP at Columbia UniversityNew York CityNew YorkUSA
- Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Cadi Irvine
- Department of Global HIVHepatitis and Sexually Transmitted Infections ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Elaine J. Abrams
- ICAP at Columbia UniversityNew York CityNew YorkUSA
- Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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Lyerly AD, Beigi R, Bekker L, Chi BH, Cohn SE, Diallo DD, Eron J, Faden R, Jaffe E, Kashuba A, Kasule M, Krubiner C, Little M, Mfustso‐Bengo J, Mofenson L, Mwapasa V, Mworeko L, Myer L, Penazzato M, Rid A, Shapiro R, Singh JA, Sullivan K, Vicari M, Wambui J, White A, Wickremsinhe M, Wolf L. Ending the evidence gap for pregnancy, HIV and co-infections: ethics guidance from the PHASES project. J Int AIDS Soc 2021; 24:e25846. [PMID: 34910846 PMCID: PMC8673925 DOI: 10.1002/jia2.25846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION While pregnant people have been an important focus for HIV research, critical evidence gaps remain regarding prevention, co-infection, and safety and efficacy of new antiretroviral therapies in pregnancy. Such gaps can result in harm: without safety data, drugs used may carry unacceptable risks to the foetus or pregnant person; without pregnancy-specific dosing data, pregnant people face risks of both toxicity and undertreatment; and delays in gathering evidence can limit access to beneficial next-generation drugs. Despite recognition of the need, numerous barriers and ethical complexities have limited progress. We describe the process, ethical foundations, recommendations and applications of guidance for advancing responsible inclusion of pregnant people in HIV/co-infections research. DISCUSSION The 26-member international and interdisciplinary Pregnancy and HIV/AIDS: Seeking Equitable Study (PHASES) Working Group was convened to develop ethics-centred guidance for advancing timely, responsible HIV/co-infections research with pregnant people. Deliberations over 3 years drew on extensive qualitative research, stakeholder engagement, expert consultation and a series of workshops. The guidance, initially issued in July 2020, highlights conceptual shifts needed in framing research with pregnant people, and articulates three ethical foundations to ground recommendations: equitable protection from drug-related risks, timely access to biomedical advances and equitable respect for pregnant people's health interests. The guidance advances 12 specific recommendations, actionable within the current regulatory environment, addressing multiple stakeholders across drug development and post-approval research, and organized around four themes: building capacity, supporting inclusion, achieving priority research and ensuring respect. The recommendations describe strategies towards ethically redressing the evidence gap for pregnant people around HIV and co-infections. The guidance has informed key efforts of leading organizations working to advance needed research, and identifies further opportunities for impact by a range of stakeholder groups. CONCLUSIONS There are clear pathways towards ethical inclusion of pregnant people in the biomedical research agenda, and strong agreement across the HIV research community about the need for - and the promise of - advancing them. Those who fund, conduct, oversee and advocate for research can use the PHASES guidance to facilitate more, better and earlier evidence to optimize the health and wellbeing of pregnant people and their children.
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Affiliation(s)
- Anne Drapkin Lyerly
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Richard Beigi
- Department of ObstetricsGynecology & Reproductive SciencesUPMC Magee‐Women's HospitalPittsburghPennsylvaniaUSA
| | - Linda‐Gail Bekker
- Desmond Tutu HIV Centre and Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Benjamin H. Chi
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Susan E. Cohn
- Department of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Joseph Eron
- Department of Medicine and Center for AIDS ResearchUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Ruth Faden
- Johns Hopkins Berman Institute of BioethicsBaltimoreMarylandUSA
| | - Elana Jaffe
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Angela Kashuba
- Eshelman School of Pharmacy and Department of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Mary Kasule
- Botswana‐Baylor Centre for Clinical ExcellenceGabaroneBotswana
| | | | - Maggie Little
- Kennedy Institute for Ethics and Department of PhilosophyGeorgetown UniversityWashingtonDCUSA
| | - Joseph Mfustso‐Bengo
- Center of Bioethics for Eastern & Southern Africa and Department of Health Systems and PolicyCollege of MedicineUniversity of MalawiZombaMalawi
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern AfricaKampalaUganda
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | | | - Annette Rid
- Department of BioethicsThe Clinical CenterNational Institutes of HealthBethesdaMarylandUSA
| | - Roger Shapiro
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jerome Amir Singh
- Howard College School of LawUniversity of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
- Dalla Lana School of Public Health Sciences, University of TorontoTorontoOntarioCanada
| | - Kristen Sullivan
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Jacque Wambui
- National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK)African Communities Advisory Board (AfroCAB)LusakaZambia
| | - Amina White
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marisha Wickremsinhe
- Ethox Centre and Wellcome Centre for Ethics and HumanitiesUniversity of OxfordOxfordUK
| | - Leslie Wolf
- Center for LawHealth & Society and College of Law and School of Public HealthGeorgia State UniversityAtlantaGeorgiaUSA
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9
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Penazzato M, Lewis L, Watkins M, Prabhu V, Pascual F, Auton M, Kreft W, Morin S, Vicari M, Lee J, Jamieson D, Siberry GK. Shortening the decade-long gap between adult and paediatric drug formulations: a new framework based on the HIV experience in low- and middle-income countries. J Int AIDS Soc 2019; 21 Suppl 1. [PMID: 29485727 PMCID: PMC5978668 DOI: 10.1002/jia2.25049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/18/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Despite the coordinated efforts by several stakeholders to speed up access to HIV treatment for children, development of optimal paediatric formulations still lags 8 to 10 years behind that of adults, due mainly to lack of market incentives and technical complexities in manufacturing. The small and fragmented paediatric market also hinders launch and uptake of new formulations. Moreover, the problems affecting HIV similarly affect other disease areas where development and introduction of optimal paediatric formulations is even slower. Therefore, accelerating processes for developing and commercializing optimal paediatric drug formulations for HIV and other disease areas is urgently needed. Discussion The Global Accelerator for Paediatric Formulations (GAP‐f) is an innovative collaborative model that will accelerate availability of optimized treatment options for infectious diseases, such as HIV, tuberculosis and viral hepatitis, affecting children in low‐ and middle‐income countries (LMICs). It builds on the HIV experience and existing efforts in paediatric drug development, formalizing collaboration between normative bodies, research networks, regulatory agencies, industry, supply and procurement organizations and funding bodies. Upstream, the GAP‐f will coordinate technical support to companies to design and study optimal paediatric formulations, harmonize efforts with regulators and incentivize manufacturers to conduct formulation development. Downstream, the GAP‐f will reinforce coordinated procurement and communication with suppliers. The GAP‐f will be implemented in a three‐stage process: (1) development of a strategic framework and promotion of key regulatory efficiencies; (2) testing of feasibility and results, building on the work of existing platforms such as the Paediatric HIV Treatment Initiative (PHTI) including innovative approaches to incentivize generic development and (3) launch as a fully functioning structure. Conclusions GAP‐f is a key partnership example enhancing North‐South and international cooperation on and access to science and technology and capacity building, responding to Sustainable Development Goal (SDG) 17.6 (technology) and 17.9. (capacity‐building). By promoting access to the most needed paediatric formulations for HIV and high‐burden infectious diseases in low‐and middle‐income countries, GAP‐f will support achievement of SDG 3.2 (infant mortality), 3.3 (end of AIDS and combat other communicable diseases) and 3.8 (access to essential medicines), and be an essential component of meeting the global Start Free, Stay Free, AIDS Free super‐fast‐track targets.
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Affiliation(s)
| | - Linda Lewis
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | | | - Martin Auton
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Wesley Kreft
- Partnership for Supply Chain Management, Amsterdam, the Netherlands
| | | | | | - Janice Lee
- Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - David Jamieson
- Partnership for Supply Chain Management, Washington, DC, USA
| | - George K Siberry
- Office of the U.S. Global AIDS Coordinator, U.S. Department of State, Washington, DC, USA
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10
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Penazzato M, Irvine C, Vicari M, Essajee SM, Sharma A, Puthanakit T, Abrams EJ, Doherty M. A Global Research Agenda for Pediatric HIV. J Acquir Immune Defic Syndr 2019; 78 Suppl 1:S10-S15. [PMID: 29994914 PMCID: PMC6075892 DOI: 10.1097/qai.0000000000001743] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Despite progress, 2016 still saw 160,000 new infections and 120,000 AIDS-related deaths among children. Evidence gaps on how to best diagnose, treat, and deliver services to children living with HIV remain. A global research prioritization exercise was undertaken by WHO and CIPHER to focus research efforts in the context of diminishing resources. Methods: The Child Health and Nutrition Research Initiative methodology was adapted and used, as described by Irvine et al.1 Outcomes were reviewed by an expert group and 5 priority themes identified for testing, antiretroviral treatment, and service delivery, accounting for existing policies, published literature and ongoing research. Results: A total of 749 questions were submitted by 269 individuals from 62 countries. For HIV testing, priority themes included strategies and interventions to improve access, uptake and linkage to care, including with novel diagnostic tools and entry points beyond antenatal care. For treatment, priorities included strategies to improve adherence, short- and long-term outcomes and management of coinfections, optimal drug formulations, and early ART. For service delivery, priorities included strategies or interventions to improve access, uptake and retention in care, including psychosocial and family support and approaches to HIV disclosure and reduction of stigma and discrimination. Conclusions: This is the largest Child Health and Nutrition Research Initiative exercise undertaken in HIV. The results provide guidance to focus future research in pediatric HIV for impact. Global commitment to support priority research, adequate investment, and strong leadership is urgently needed to improve the health and well-being of children living with and affected by HIV.
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Affiliation(s)
- Martina Penazzato
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Cadi Irvine
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland.,Department of HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | - Marissa Vicari
- Department of HIV Programmes and Advocacy, International AIDS Society, Geneva, Switzerland
| | | | | | - Thanyawee Puthanakit
- Department of Pediatrics, Center of Excellence in Pediatric Infectious Diseases and Vaccine, Faculty of Medicine, Chulalongkorn University
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, and College of Physicians & Surgeons, Columbia University, New York, NY
| | - Meg Doherty
- Department of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
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11
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Penazzato M, Watkins M, Morin S, Lewis L, Pascual F, Vicari M, Lee J, Hargreaves S, Doherty M, Siberry GK. Catalysing the development and introduction of paediatric drug formulations for children living with HIV: a new global collaborative framework for action. The Lancet HIV 2018; 5:e259-e264. [DOI: 10.1016/s2352-3018(18)30005-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/08/2018] [Indexed: 01/15/2023]
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12
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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13
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Slogrove AL, Becquet R, Chadwick EG, Côté HCF, Essajee S, Hazra R, Leroy V, Mahy M, Murenga M, Wambui Mwangi J, Oyiengo L, Rollins N, Penazzato M, Seage GR, Serghides L, Vicari M, Powis KM. Surviving and Thriving-Shifting the Public Health Response to HIV-Exposed Uninfected Children: Report of the 3rd HIV-Exposed Uninfected Child Workshop. Front Pediatr 2018; 6:157. [PMID: 29900165 PMCID: PMC5989128 DOI: 10.3389/fped.2018.00157] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/10/2018] [Indexed: 11/15/2022] Open
Abstract
Great gains were achieved with the introduction of the United Nations' Millennium Development Goals, including improved child survival. Transition to the Sustainable Development Goals (SDGs) focused on surviving, thriving, and transforming, representing an important shift to a broader public health goal, the achievement of which holds the promise of longer-term individual and societal benefits. A similar shift is needed with respect to outcomes for infants born to women living with HIV (WLHIV). Programming to prevent vertical HIV transmission has been successful in increasingly achieving a goal of HIV-free survival for infants born to WLHIV. Unfortunately, HIV-exposed uninfected (HEU) children are not achieving comparable health and developmental outcomes compared with children born to HIV-uninfected women under similar socioeconomic circumstances. The 3rd HEU Child Workshop, held as a satellite session of the International AIDS Society's 9th IAS Conference in Paris in July 2017, provided a venue to discuss HEU child health and development disparities. A summary of the Workshop proceedings follows, providing current scientific findings, emphasizing the gap in systems for long-term monitoring, and highlighting the public health need to establish a strategic plan to better quantify the short and longer-term health and developmental outcomes of HEU children.
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Affiliation(s)
- Amy L Slogrove
- Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| | - Renaud Becquet
- Bordeaux Population Health Research Center, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
| | - Ellen G Chadwick
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Health and Human Development, National Institute of Health, Bethesda, MD, United States
| | - Valériane Leroy
- French Institute of Health and Medical Research, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Mary Mahy
- Strategic Information Department, UNAIDS, Geneva, Switzerland
| | | | | | | | - Nigel Rollins
- HIV Department, World Health Organization, Geneva, Switzerland
| | | | - George R Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - Marissa Vicari
- Collaborative Initiative for Paediatric HIV Education and Research, International AIDS Society, Geneva, Switzerland
| | - Kathleen M Powis
- Departments of Internal Medicine and Pediatrics, Masschusetts General Hospital, Boston, MA, United States.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Dodet B, Hesselink W, Jungbäck C, Léchenet J, Pastoret PP, Vannier P, Vicari M. Viral safety and extraneous agents testing for veterinary vaccines. Biologicals 2010; 38:326-31. [PMID: 20503495 DOI: 10.1016/j.biologicals.2010.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Betty Dodet
- DBS, 6 Bis, Rue de Verdun, 69300 Caluire et Cuire, France
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Effa P, Massougbodji A, Ntoumi F, Hirsch F, Debois H, Vicari M, Derme A, Ndemanga-Kamoune J, Nguembo J, Impouma B, Akué JP, Ehouman A, Dieye A, Kilama W. Ethics committees in western and central Africa: concrete foundations. Dev World Bioeth 2007; 7:136-42. [PMID: 18021118 DOI: 10.1111/j.1471-8847.2006.00172.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The involvement of developing countries in international clinical trials is necessary for the development of appropriate medicines for local populations. However, the absence of appropriate structures for ethical review represents a barrier for certain countries. Currently there is very little information available on existing structures dedicated to ethics in western and central Africa. This article briefly describes historical milestones in the development of networks dedicated to capacity building in ethical review in these regions and outlines the major conclusions of two workshops on this issue, which were held in September and October 2002 in Libreville, Gabon, and Paris, France. The workshops were the culmination of collaboration between the African Malaria Network Trust (AMANET) and the Pan African Bioethics Initiative (PABIN). They produced an update on ethics organizations with regard to mission, function, activities, members, and contact people, in eight countries within the regions discussed. As a result of the commitment of mandated delegates, a further prominent outcome followed these workshops: the creation of national structures, where none existed before, dedicated to the ethical review of clinical trials.
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Affiliation(s)
- Luc Aujame
- Campus Mérieux, 69280 Marcy l'Etoile, France.
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de WG, Berghmans RL, Boer GJ, Andersen S, Brambati B, Carvalho AS, Dierickx K, Elliston S, Nunez P, Osswald W, Vicari M. Ethical guidance on human embryonic and fetal tissue transplantation: a European overview. Med Health Care Philos 2002; 5:79-90. [PMID: 11954997 DOI: 10.1023/a:1014213125573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article presents an overview of regulations, guidelines and societal debates in eight member states of the EC about a) embryonic and fetal tissue transplantation (EFTT), and b) the use of human embryonic stem cells (hES cells) for research into cell therapy, including 'therapeutic' cloning. There appears to be a broad acceptance of EFTT in these countries. In most countries guidance has been developed. There is a 'strong' consensus about some of the central conditions for 'good clinical practice' regarding EFTT. International differences concern, amongst others, some of the informed consent issues involved, and the questions whether an intermediary organisation is necessary, whether the methods of abortion may be influenced by the possible use of EFT, and whether EFTT should only be used for the experimental treatment of rare disorders. The potential use of hES cells for research into cell therapy has given a new impetus to the debate about (human) embryo research. The therapeutic prospects with regard to the retrieval and research use of hES cells appear to function as a catalyst for the introduction of less restrictive regulations concerning research with spare embryos, at least in some European countries. It remains to be seen whether the prospect of treating patients suffering from serious disorders with transplants produced by therapeutic cloning will decrease the societal and moral resistance to allowing the generation of embryos for 'instrumental' use.
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Affiliation(s)
- Wert G de
- Institute for Bioethics, Maastricht, The Netherlands.
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Vicari M, Ogle V. Comparison of measurements of cardiac output from the side port versus the proximal lumen of the Swan-Ganz catheter: follow-up study. Heart Lung 1987; 16:379-80. [PMID: 3647974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Turitto G, Dini P, Rocca P, Vicari M, Zanchi E, Prati PL. [Characterization and therapy of ventricular arrhythmias due to transient myocardial ischemic attacks in variant angina]. G Ital Cardiol 1984; 14:663-70. [PMID: 6510621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Forty-two patients with variant angina were studied by ambulatory ECG monitoring to determine the incidence and the characteristics of ventricular arrhythmias during ischemic attacks. Twenty-six patients had no ventricular arrhythmias in 633 ischemic attacks; 16 patients had ventricular arrhythmias in 116/586 ischemic attacks. The number of ischemic attacks per day and the magnitude of ST elevation were significantly (p less than 0.05) greater in patients with ventricular arrhythmias. Ventricular arrhythmias appeared at the onset or at the peak of ST elevation (first phase) in 17 ischemic attacks, during the resolution of ST elevation (second phase) in 43 attacks, during both the phases in 9 attacks. ST alternans appeared during 6 ischemic attacks with arrhythmias. Two episodes of ventricular fibrillation and 22 runs of ventricular tachycardia occurred during the first phase, 17 episodes of ventricular tachycardia were recorded during the second phase. Ventricular tachycardia of the second phase compared with ventricular tachycardias of the first phase were significantly (p less than 0.01) slower, uniform and initiated by a late premature beat. Incidence of arrhythmias of the second phase was strictly correlated with the duration of ischemic attacks. Nine patients who showed ventricular arrhythmias during the second phase of ischemic attacks were enrolled in a cross-over study to assess the antiarrhythmic effects of nifedipine (120 mg/day) and verapamil (480 mg/day). During treatment with nifedipine, the frequency of ischemic attacks declined by 85%, while the frequency of attacks with arrhythmias declined by 97% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Coletta C, Di Segni M, Vicari M, Boccanelli A, Gambelli G. [Pulsed Doppler echocardiography in the study of tricuspid valve insufficiency]. G Ital Cardiol 1983; 13:25-31. [PMID: 6642123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The value of pulsed Doppler echocardiography in assessing the presence and severity of tricuspid regurgitation (TR) has been studied in three groups of subjects, 12 without cardiovascular disease (Group I), 38 with TR (Group II) and 16 patients with aortic and mitral valve disease but no TR (Group III). The presence and severity of TR was also independently evaluated by clinical examination, jugular vein pulse recording and/or hemodynamic investigation. Left parasternal, sub-xyphoid and apical views were adapted for the pulsed Doppler echocardiographic examination. The sample volume was placed in the right atrium at varying distances from the tricuspid valve. We tried to quantitate the degree of TR according to: 1) the diameter and maximal distance from the tricuspid valve of the regurgitant stream, 2) the duration of reguritation through systole, and 3) the degree of turbolence as demonstrated by the time interval histograms. On the basis of above mentioned criteria, three subgroups of subjects with TR, i.e. mild, moderate and severe were recognised. These results were compared to hemodynamic and/or clinical-poligraphic evaluation. In 34 Group II subjects (89%), the Doppler study revealed the presence of TR and allowed an acceptable quantitative assessment. Falsely positive diagnoses were not made in any of the subjects of Group I. Identification of organic TR in patients with atrial fibrillation was possible only when regurgitation was moderate or severe.
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