HIV Epidemiology.

Lead Research Organisation: University College London

Abstract

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.

Technical Summary

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.

Publications

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AIDS-Defining Cancer Project Working Group For IeDEA And COHERE In EuroCoord (2017) Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Antiretroviral Therapy Cohort Collaboration (ART-CC) (2016) Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis. in AIDS (London, England)

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Booth JW (2016) Clinical characteristics and outcomes of HIV-associated immune complex kidney disease. in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

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Caniglia EC (2018) Commonly Prescribed Antiretroviral Therapy Regimens and Incidence of AIDS-Defining Neurological Conditions. in Journal of acquired immune deficiency syndromes (1999)

 
Description BHIVA guidelines committee
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact Professor Dunn is a member of the British HIV Association treatment guidelines committee
 
Description Framework contract
Amount € 243,537 (EUR)
Funding ID ECDC.6571 
Organisation European Centre for Disease Prevention and Control (ECDC) 
Sector Public
Country Sweden
Start 09/2016 
End 08/2020
 
Description provision of service contract
Amount € 40,000 (EUR)
Funding ID ECD.5661 
Organisation European Centre for Disease Prevention and Control (ECDC) 
Sector Public
Country Sweden
Start 08/2015 
End 08/2016
 
Description BEEHIVE 
Organisation Imperial College London
Department Section of Endocrinology and Investigative Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution Provided data and samples from HIV seroconverters
Collaborator Contribution Whole genome sequencing of HIV from individuals samples at the time of their viral set point
Impact None yet
Start Year 2014
 
Description EuroCoord 
Organisation European Commission
Country European Union (EU) 
Sector Public 
PI Contribution I was the Principal Investigator for EuroCoord, an EU-funded Network of Excellence of HIV cohort studies. The network was managed by my team. Although I was specifically responsible for 2 of the 15 workpackages the aims of which were to provide the framework within which to conduct and analyse data from HIV seroconverters by: Pooling and enlarging the datasets available for analyses to address pre-specified objectives and future questions arising in the lifetime of the project Implementing a harmonisation process for the collection of key socio-economic variables (in collaboration with WP14) Establishing the infrastructure and know-how to estimate HIV incidence in Central & Eastern European countries. The WPs also aim to characterise newly-acquired HIV infection, its contribution to the epidemic, and to assess outcome and its determinants in individuals with early diagnosis, focussing on: Applying techniques which distinguish recent from chronic HIV infection and testing populations Assessing the outcome of infected individuals following infection Identifying differences in disease progression Determining viral and host genetic factors and their relevance to outcome. As project Leader, I had overall responsibility for all 15 workpackages
Collaborator Contribution EuroCoord is made up of 25 beneficiaries from 16 countries to ensure representativeness across Europe. The nature of the collaboration means that apart from these partners, there is also an associated network of numerous affiliated sites - more than 100 collaborating centres, or third parties. The tasks of EuroCoord are organised into 15 different workpackages, all of which are interrelated, and unified through the scientific oversight workpackage. The overarching aim of EuroCoord is to use the scientific strengths of each collaboration to ensure that the best, most competitive research is performed. Such a large, integrated network has allowed a common virtual database to be established, which currently has access to data from > 300,000 HIV-infected individuals from many different settings across Europe and beyond. EuroCoord's multidisciplinary approach allows the following key areas of HIV research to be addressed, aimed at improving the management and life of HIV-infected individuals, whilst allowing us to explore differences within sub-groups: Characterising HIV infected populations in Europe (including the epidemiology of different subtypes) Improving our understanding of pathogenesis (including understanding the mechanisms of non-progression) Documenting uptake of and response to therapy Evaluating the implications of long-term HIV infection and exposure to therapy Assessing the implications of specific management strategies Improving the management of hepatitis co-infection Tuberculosis (TB) among HIV-infected patients HIV and AIDS in migrant populations in Europe Modelling the HIV infected population in Europe. The Network also established training programmes to improve research skills, e.g. statistical techniques to allow researchers to undertake observational research of the highest caliber, basic and updated laboratory and clinical training to aid the management of HIV-infected patients.
Impact the network was multidisciplinary being made up of clinicians, public health specialists, epidemiologists, statisticians, bioinformaticians, virologists >100 publications arose from EuroCoord many of which contributed to HIV treatment guidelines- these are listed here http://www.eurocoord.net/publications_and_presentations no systematic information was kept of postgraduate thesis arising from EuroCoord but the data contributed to >10 PhDs and ~5 MSc projects, 2 of whom were on MRC studentships
Start Year 2011
 
Description HEATHER 
Organisation University of Oxford
Department Experimental Medicine Division
Country United Kingdom 
Sector Hospitals 
PI Contribution Design of study, idenifying eligible patients, design of database, analysis
Collaborator Contribution Clinical follow-up, measuring HIV reservoir, analysis
Impact none yet
Start Year 2014
 
Description HGC 
Organisation The Wellcome Trust Sanger Institute
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Phenotype defitions were based on my team's work on evaluation of various definitions. The UK Register, for which I'm PI, had already amassed data and samples from eligible individuals- making it possible for the project to achieve objectives and meet deadlines
Collaborator Contribution Provided funding for sequencing and the expertise to undertake the appropriate analyses
Impact A systematic review of definitions of extreme phenotypes of HIV control and progression. Gurdasani D, Iles L, Dillon DG, Young EH, Olson AD, Naranbhai V, Fidler S, Gkrania-Klotsas E, Post FA, Kellam P, Porter K, Sandhu MS. AIDS. 2014 Jan 14;28(2):149-62. doi: 10.1097/QAD.0000000000000049. Review. An evaluation of HIV elite controller definitions within a large seroconverter cohort collaboration. Olson AD, Meyer L, Prins M, Thiebaut R, Gurdasani D, Guiguet M, Chaix ML, Amornkul P, Babiker A, Sandhu MS, Porter K; CASCADE Collaboration in EuroCoord. PLoS One. 2014 Jan 28;9(1):e86719. doi: 10.1371/journal.pone.0086719. eCollection 2014.
Start Year 2012
 
Description Improving monitoring of the continuum of HIV 
Organisation Amsterdam Medical Center
Department Clinical Immunology and Rheumatology KIR (AMC-R)
Country Netherlands 
Sector Hospitals 
PI Contribution Following on from an earlier funded collaboration, I led a consortium funded by ECDC comprising colleagues from INSERM (DR Paris 6), National and Kapodistrian University of Athens, Academic Medical Center (Amsterdam) and the National Institute of Public Health- National Institute of Hygiene (Warsaw). The aim is to improve the monitoring of the HIV continuum of care by synthesising and further developing definitions, improving data sources, and identifying ways of overcoming some of the challenges faced in constructing HIV continuums. Specifically: • Describing the rational for measuring and monitoring a four-point continuum of HIV care. • Providing advice regarding options for European countries in measuring the continuum of HIV care, given their available data sources. • Describing how countries in the WHO European Region are meeting the UNAIDS 90-90-90 target by summarising continuum of HIV care data, collected through activities monitoring the Dublin Declaration.
Collaborator Contribution Providing expert technical support to countries to assist them in developing their capacity to construct national continuums of HIV care, through training (e.g. on modelling) or by recommending suitable methods and possible enhancements to data collection systems, as necessary and feasible Construction of HIV care continuums by key populations using clinical cohort and HIV surveillance data Methodological development of HIV continuum of care concepts, broadly contributing to the development of definitions for the continuum of care, but specifically exploring the feasibility and utility of using longitudinal measures related to timeliness of each element, such as the time from HIV infection to diagnosis
Impact The outputs have all been in the form of publications (included) in the relevant section The collaboration is not multi-disciplinary
Start Year 2016
 
Description Improving monitoring of the continuum of HIV 
Organisation European Centre for Disease Prevention and Control (ECDC)
Country Sweden 
Sector Public 
PI Contribution Following on from an earlier funded collaboration, I led a consortium funded by ECDC comprising colleagues from INSERM (DR Paris 6), National and Kapodistrian University of Athens, Academic Medical Center (Amsterdam) and the National Institute of Public Health- National Institute of Hygiene (Warsaw). The aim is to improve the monitoring of the HIV continuum of care by synthesising and further developing definitions, improving data sources, and identifying ways of overcoming some of the challenges faced in constructing HIV continuums. Specifically: • Describing the rational for measuring and monitoring a four-point continuum of HIV care. • Providing advice regarding options for European countries in measuring the continuum of HIV care, given their available data sources. • Describing how countries in the WHO European Region are meeting the UNAIDS 90-90-90 target by summarising continuum of HIV care data, collected through activities monitoring the Dublin Declaration.
Collaborator Contribution Providing expert technical support to countries to assist them in developing their capacity to construct national continuums of HIV care, through training (e.g. on modelling) or by recommending suitable methods and possible enhancements to data collection systems, as necessary and feasible Construction of HIV care continuums by key populations using clinical cohort and HIV surveillance data Methodological development of HIV continuum of care concepts, broadly contributing to the development of definitions for the continuum of care, but specifically exploring the feasibility and utility of using longitudinal measures related to timeliness of each element, such as the time from HIV infection to diagnosis
Impact The outputs have all been in the form of publications (included) in the relevant section The collaboration is not multi-disciplinary
Start Year 2016
 
Description Improving monitoring of the continuum of HIV 
Organisation National Institute of Health and Medical Research (INSERM)
Department Institute of Metabolic and Cardiovascular Disease (I2MC)
Country France 
Sector Public 
PI Contribution Following on from an earlier funded collaboration, I led a consortium funded by ECDC comprising colleagues from INSERM (DR Paris 6), National and Kapodistrian University of Athens, Academic Medical Center (Amsterdam) and the National Institute of Public Health- National Institute of Hygiene (Warsaw). The aim is to improve the monitoring of the HIV continuum of care by synthesising and further developing definitions, improving data sources, and identifying ways of overcoming some of the challenges faced in constructing HIV continuums. Specifically: • Describing the rational for measuring and monitoring a four-point continuum of HIV care. • Providing advice regarding options for European countries in measuring the continuum of HIV care, given their available data sources. • Describing how countries in the WHO European Region are meeting the UNAIDS 90-90-90 target by summarising continuum of HIV care data, collected through activities monitoring the Dublin Declaration.
Collaborator Contribution Providing expert technical support to countries to assist them in developing their capacity to construct national continuums of HIV care, through training (e.g. on modelling) or by recommending suitable methods and possible enhancements to data collection systems, as necessary and feasible Construction of HIV care continuums by key populations using clinical cohort and HIV surveillance data Methodological development of HIV continuum of care concepts, broadly contributing to the development of definitions for the continuum of care, but specifically exploring the feasibility and utility of using longitudinal measures related to timeliness of each element, such as the time from HIV infection to diagnosis
Impact The outputs have all been in the form of publications (included) in the relevant section The collaboration is not multi-disciplinary
Start Year 2016
 
Description Improving monitoring of the continuum of HIV 
Organisation National and Kapodistrian University of Athens
Department University of Athens Medical School
Country Greece 
Sector Academic/University 
PI Contribution Following on from an earlier funded collaboration, I led a consortium funded by ECDC comprising colleagues from INSERM (DR Paris 6), National and Kapodistrian University of Athens, Academic Medical Center (Amsterdam) and the National Institute of Public Health- National Institute of Hygiene (Warsaw). The aim is to improve the monitoring of the HIV continuum of care by synthesising and further developing definitions, improving data sources, and identifying ways of overcoming some of the challenges faced in constructing HIV continuums. Specifically: • Describing the rational for measuring and monitoring a four-point continuum of HIV care. • Providing advice regarding options for European countries in measuring the continuum of HIV care, given their available data sources. • Describing how countries in the WHO European Region are meeting the UNAIDS 90-90-90 target by summarising continuum of HIV care data, collected through activities monitoring the Dublin Declaration.
Collaborator Contribution Providing expert technical support to countries to assist them in developing their capacity to construct national continuums of HIV care, through training (e.g. on modelling) or by recommending suitable methods and possible enhancements to data collection systems, as necessary and feasible Construction of HIV care continuums by key populations using clinical cohort and HIV surveillance data Methodological development of HIV continuum of care concepts, broadly contributing to the development of definitions for the continuum of care, but specifically exploring the feasibility and utility of using longitudinal measures related to timeliness of each element, such as the time from HIV infection to diagnosis
Impact The outputs have all been in the form of publications (included) in the relevant section The collaboration is not multi-disciplinary
Start Year 2016
 
Description Improving monitoring of the continuum of HIV 
Organisation Polish National Institute of Public Health
Country Poland 
Sector Public 
PI Contribution Following on from an earlier funded collaboration, I led a consortium funded by ECDC comprising colleagues from INSERM (DR Paris 6), National and Kapodistrian University of Athens, Academic Medical Center (Amsterdam) and the National Institute of Public Health- National Institute of Hygiene (Warsaw). The aim is to improve the monitoring of the HIV continuum of care by synthesising and further developing definitions, improving data sources, and identifying ways of overcoming some of the challenges faced in constructing HIV continuums. Specifically: • Describing the rational for measuring and monitoring a four-point continuum of HIV care. • Providing advice regarding options for European countries in measuring the continuum of HIV care, given their available data sources. • Describing how countries in the WHO European Region are meeting the UNAIDS 90-90-90 target by summarising continuum of HIV care data, collected through activities monitoring the Dublin Declaration.
Collaborator Contribution Providing expert technical support to countries to assist them in developing their capacity to construct national continuums of HIV care, through training (e.g. on modelling) or by recommending suitable methods and possible enhancements to data collection systems, as necessary and feasible Construction of HIV care continuums by key populations using clinical cohort and HIV surveillance data Methodological development of HIV continuum of care concepts, broadly contributing to the development of definitions for the continuum of care, but specifically exploring the feasibility and utility of using longitudinal measures related to timeliness of each element, such as the time from HIV infection to diagnosis
Impact The outputs have all been in the form of publications (included) in the relevant section The collaboration is not multi-disciplinary
Start Year 2016