Infants, Children Adolescents: Unique considerations for infants, children, and adolescents with respect to the pathogenesis of HIV infection warrant research specifically focused on these populations. As potent therapy has become available, HIV infection has become more of a chronic disease than a terminal condition in both adults and children. A recent study found that more than one-half of perinatally HIV-infected children in the United States are over the age of 15 years. Studies from resource-limited countries are beginning to show similar survival of this population into adolescence and young adulthood as access to antiretroviral therapy expands. Increased survival of HIV-infected children has been associated with challenges in maintaining adherence to long-term, likely lifelong, therapy and in selecting successive antiretroviral drug regimens. This is further complicated by the limited availability of pediatric formulations and of pharmacokinetic and safety data in children and the development of extensive drug resistance in multi-drug-experienced children. In resource-limited countries, pediatric HIV infection and its therapy is further complicated by the presence of endemic diseases, such as tuberculosis, hepatitis, and malaria, and co-morbidities, such as malnutrition, that may exacerbate HIV disease and further complicate therapy.
Current specific areas of research on HIV in children and adolescents in the antiretroviral era both domestically and internationally include:
Women: The MPIDB also has a strong focus on HIV in women. Worldwide, HIV prevalence in women is increasing, and transmission during heterosexual intercourse is the primary means by which women become infected. A range of factors contribute to women's increased vulnerability to HIV-1 acquisition, including biology and structural and socioeconomic factors that define gender inequality in different contexts, but knowledge about the role of these factors remains limited. The complex interactions of HIV and its treatment with endogenous hormonal fluctuations over the course of a woman's life, from puberty through menopause—including exogenous hormonal utilization—are also not well understood. Research in this area is funded by the Branch through investigator-initiated grants and clinical trials networks, and NICHD and the National Institute of Allergy and Infectious Diseases co-fund the Women's Interagency HIV Study (WIHS) , the largest domestic cohort of HIV-infected and atrisk women. Areas of research interests include:
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