Epidemiology and Natural History of HIV Infection and HIV-Related Co-Infections in Pregnant and Non-Pregnant Women, Infants, Children, and Adolescents

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:

  • Epidemiology/natural history with a focus on children in resource-limited countries
    • Optimizing linkage to care, monitoring of therapy, adherence and durability of therapy, and development of drug resistance
    • Short- and long-term outcomes of HIV and its treatment in children along the entire spectrum of HIV care, including transitions to adult care, and patient and site-level factors associated with these outcomes
    • Evaluation of epidemiology, treatment, and prevention of important co-infections in children, particularly tuberculosis, malaria, hepatitis, and other high-priority infections
  • Biomedical complications of HIV and its therapies
    • Growth, endocrinologic, bone, and dental issues (including nutritional effects)
    • Sexual maturation and reproductive capacity
    • Body composition changes and tissue redistribution syndromes
    • Cardiovascular complications and cardiovascular disease risk
    • Mitochondrial effects of exposure to antiretroviral drugs
  • Psychosocial and behavioral research
    • Neurodevelopmental, language and hearing, cognitive, academic, vocational, and behavioral outcomes
    • Disclosure of HIV status to children in low- and middle-income country settings
    • Adherence to therapy, including implementation and utilization of innovative technologies to assess and support adherence
  • Assay development
    • Pediatric HIV diagnostic and monitoring assays and strategies relevant to developing-country settings
    • Tuberculosis diagnostics
    • Point-of-care technologies

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) External Web Site Policy, the largest domestic cohort of HIV-infected and atrisk women. Areas of research interests include:

  • Natural history of HIV infection in women: Risk factors for HIV acquisition and disease progression, use of and response to antiretroviral therapy, and complications of HIV infection and its therapy
  • Gender-specific manifestations of HIV: Differences in immunologic and virologic parameters of HIV disease, and the gender-specific clinical manifestations of infection with HIV (e.g., cervical cancer)
  • Impact of therapy on HIV infection in women: Benefits in slowing disease progression and improving survival; complications of therapy; interactions with other chronic infections, such as hepatitis c virus; and impact on concomitant conditions, such as genital neoplasia
  • Interactions of HIV acquisition and HIV disease progression with endogenous and exogenous hormones: The relationship between hormones and interaction of menopause and changes related to aging on HIV infection, viral load and genital viral shedding, and complications of therapy, including pharmacologic interactions between hormonal replacement or contraceptive treatment and antiretroviral therapies
  • HIV sexual transmission: Enhanced understanding of the biologic mechanisms of transmission to women, and prevention of heterosexual transmission through use of microbicides or pre-/post-exposure antiretroviral prophylaxis
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