HIV Epidemiology.

This is mainly a programme of studies following up adults and children with HIV and fits in well with the clinical trials programme. This is because these studies can highlight areas where more investigative studies like clinical trials need to be done. They are also important in helping statisticians to design these trials and allow us to follow people up over the longer term to see how they do beyond the time that they re in the clinical trials.||The observational studies in adults are the UK Register of HIV Seroconverters, which led to a bigger collaboration called CASCADE funded by the European Commission, and which the UK Register is now part of. CASCADE was first funded in 1997 and brings together experts conducting 23 studies in 15 European countries, Australia and Canada. The studies have one thing in common in that they are of HIV infected people for whom we have a reasonably accurate date of when they became infected, or seroconverted. Information from these seroconverters allow us to follow-up people who ve recently become infected throughout the whole period since they came in contact with the virus.||A study in children called CHIPS (Collaborative HIV Paediatric Study) was established in April 2000, and follows-up HIV infected children in the UK and Ireland. CHIPS is a collaboration between centres caring for HIV-infected children, many of whom are enrolled in PENTA trials (the Paediatric European Network for the Treatment of AIDS), the National Study of HIV in Pregnancy and Childhood (NSHPC) at the Institute of Child Health, and the MRC CTU. The main objectives of CHIPS are to describe clinical, laboratory and treatment data for these children, as well as their use of paediatric HIV services. CHIPS aims to enhance the exchange of information and expertise between centres in order to promote standardised high quality paediatrician-led care of all HIV-infected children in the UK and Ireland.||The UK HIV Drug Resistance Database is a central repository for resistance tests performed as part of routine clinical care throughout the UK. Established in 2001, by the end of 2007 over 51,000 test results have been received and stored. A key feature of the Database is extensive patient-level linkage with several clinical cohorts and surveillance databases in the UK. This has allowed analyses which have given important insights into the epidemiology and clinical aspects of HIV drug resistance.||Evidence for Action (EfA) is a five-year international research programme funded from the UK Department for International Development. EfA focuses on HIV treatment and care systems and the goal of the research programme is to contribute to knowledge on how to design, manage and deliver comprehensive HIV treatment and care programmes in resource-poor settings. The programme will provide evidence-informed, practical recommendations to policy makers, programme managers and funding agencies on how to maximise the benefits and equity of HIV treatment & care systems in developing countries.

The HIV epidemiology programme largely comprises cohort studies and cohort collaborations, in adults and children, and complements the clinical trials programme. These observational studies raise questions which may then be answered by trials and are a necessary resource for trial design and sample size calculations. They also contribute to the assessment of long-term outcomes.||In adults, the UK Register of HIV Seroconverters has formed the basis for an HIV cohort collaboration (CASCADE), first established in 1997 and maintained through several successful EU funding bids, between the investigators of 23 cohorts of persons with well-estimated dates of HIV seroconversion (~20,000 seroconverters). It is currently a network of epidemiologists, statisticians, virologists and clinicians from lead HIV institutions in 15 European countries, Australia and Canada. Seroconverters are enrolled into the individual cohorts locally and nationally and are typically followed up life-long. CASCADEs main aim is to monitor newly infected individuals and those already enrolled in studies, covering the entire duration of HIV infection. The main premise is that through pooling data issues can be addressed, which cannot be reliably addressed from single studies alone.||In children, The Collaborative HIV Paediatric Study (CHIPS) was established in April 2000, and is a multi-centre cohort study of HIV infected children in the UK and Ireland. CHIPS is a collaboration between centres caring for HIV-infected children, many of whom are enrolled in PENTA trials (the Paediatric European Network for the Treatment of AIDS), the National Study of HIV in Pregnancy and Childhood (NSHPC) at the Institute of Child Health, and the MRC CTU. The main objectives of CHIPS are to describe clinical, laboratory and treatment data for these children, as well as their use of paediatric HIV services. CHIPS aims to enhance the exchange of information and expertise between centres in order to promote standardised high quality paediatrician-led care of all HIV-infected children in the UK and Ireland.||The UK HIV Drug Resistance Database is a central repository for resistance tests performed as part of routine clinical care throughout the UK. Established in 2001, by the end of 2008 over 51,000 test results have been received and stored. Most of these (around 90%) are in the form of viral gene sequences. A key feature of the Database is extensive patient-level linkage with several clinical cohorts and surveillance databases in the UK. This has allowed analyses which have given important insights into the epidemiology and clinical aspects of HIV drug resistance.||Evidence for Action (EfA) is a five-year international research programme with core funding from the UK Department for International Development. EfA focuses on HIV treatment and care systems and the goal of the research programme is to contribute to knowledge on how to design, manage and deliver comprehensive HIV treatment and care programmes in resource poor settings. The programme will provide evidence-informed, practical recommendations to policy makers, programme managers and funding agencies on how to maximise the benefits and equity of HIV treatment & care systems in developing countries.