Www.aids2014.org Integrating research into care: working with children and adolescents Mark Cotton Children’s Infectious Diseases Clinical Research Unit.

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Presentation transcript:

Integrating research into care: working with children and adolescents Mark Cotton Children’s Infectious Diseases Clinical Research Unit Tygerberg Children’s Hospital Stellenbosch University

Using data to influence policy: pre PMTCT N = episodes of hospitalization 1 st episode –Age 7.2 (1 to 141) months –Weight for age Z-score -2.6 (-6.4 to 2.5) ICU admissions 42 Deaths – 36 (40%) Burden of mother to child transmission of HIV: 5 year study of hospitalized children Cotton et al S Afr J Epidemiol Infect 1998: 13: Burden of mother to child transmission of HIV: 5 year study of hospitalized children Cotton et al S Afr J Epidemiol Infect 1998: 13: 46-49

Days in hospital & cost per year – all patients Hospital days = Hospital costs PMTCT would have saved days & costs Days Costs

Success of PMTCT in South Africa Sherman GG, S Afr Med J 2014; 104 (suppl) 235-8

% new registrations <1 year of age – Aid for AIDS

Age spectrum change over time Age at registration: Current age (2014)

Open access Free Downloads Opportunity to comment on individual articles Open access Free Downloads Opportunity to comment on individual articles

Epidemiology Treatment Mental health Neurodevelopment Cardiac effects Metabolic complications Bone health Kidney disease Chronic lung disease Disclosure (website) Executive editor - Shirin Heidari Managing editor - Mirjam Curno Executive editor - Shirin Heidari Managing editor - Mirjam Curno The challenges of success Adolescents with perinatal HIV infection Lynne Mofenson & Mark Cotton The challenges of success Adolescents with perinatal HIV infection Lynne Mofenson & Mark Cotton

Cross-section study Adolescents t/f 1999 – 2011 N = 45 Median age of transfer 18.1 years The Young & the Resistant HIV-Infected Adolescents Transfer to Adult Care St Justine, Montreal, Canada 10 Vd Linden D JPIDS 2012, Dec 19

Mode of transmission Mode of HIV transmissionn (%) Mother to child transmission32/45 (71%) Blood transfusion2/45 (4.4%) Sexual2/45 (4.4%) Unknown9/45 (20%) 11

12 Initial mono- or bi-therapy ART naive Initial cART

The young and the resilient 6 th HIV Pediatrics Workshop Same adolescents Doing well Not easy F Kakkar et al

Poorer virologic suppression in adolescents – AID for AIDS Nachega et al AIDS 2009; 51: 65-71

Adolescents and technology

Acknowledgements: Sam Waters, St. Mary’s Hospital, London Dimitri vd Linden – St. Luc, Brussels Michael Hislop & Leon Regensberg – Aid for AIDS, Medscheme