IMPAACT Community Perspective on Scientific Agenda

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IMPAACT Community Perspective on Scientific Agenda

• Dorothy Shaw, ICAB US Chair
• Mama Wandoa Mwambu, ICAB International Chair
• December 4, 2006

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ICAB Members

• Dorothy Shaw US Chair
• Mama Wandoa Mwambu International Chair
• Dawn English US Vice Chair
• Teopista Nakyanzi International Vice Chair
• Charlene Bowman
• Samantha Kuryla

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ICAB Mission

• The Mission of the ICAB is to improve the value
  of clinical research for pregnant women,
  children, adolescents and families infected with
  or affected by HIV/AIDS by being a resource to
  researchers and the global community.

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ICAB Goal

• To collaborate with researchers on behalf of the
  global community to achieve relevant, acceptable,
  and ethical research that focuses on the lives
  and issues of pregnant women, children,
  adolescents and families infected with or
  affected by HIV/AIDS.

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ICAB Scientific PrioritiesPerinatal/Maternal
Health

• ICAB Representative Mama Wandoa Mwambu
• Top Priorities
• Children of perinatally-infected treated women
• What are the long-term effects of
  perinatally-infected womens lifelong ARV
  treatment on her children? 
• (Metabolic, behavioral, cognitive, developmental
  health issues or ARV resistance in uninfected and
  infected children?)
• Interruption of transmission through
  breastfeeding  
• Effects of HAART on pregnancy outcome
  (deformities, death)

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ICAB Scientific PrioritiesPerinatal/Maternal
Health

• Additional priorities
• Impact of ARVs on womens fertility
• Study of uptake of ARV therapy looking at fear of
  deformities and sickness as co-factors
• Does ARV availability affect decision to have
  more children/reproductive choices (parity)
• Co-endorsement of MTN microbicide trials for
  adolescents

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ICAB Scientific PrioritiesComplications

• ICAB Representative Charlene Bowman
• Top Priorities
• Follow-up of a limited cohort of HIV-infected and
  exposed children into adulthood to identify
  delayed complications
• Effects of long-term treatment (i.e., how
  adolescents cope emotionally and physically with
  lifetime treatment)
• Learning disabilities, neurocognitive issues,
  behavioral problems, memory loss and mental
  health issues in HIV-positive children
• Treatment and prevention of malnutrition in
  enhancing response to TB, malarial medications
  and ARVs

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ICAB Scientific PrioritiesComplications

• Additional Priorities
• HAART-related metabolic complications including
  lipids (cholesterol, triglycerides etc.) and bone
  mineral density where it comes from, what to do
  about it, when to do something about it,
  nutrition, long-term consequences
• Interaction and effects of recreational drugs and
  ARVs in youth (ACTG and ATN collaboration)
• Cardiac dysfunction in treated HIV-infected
  children
• Prevalence, risk factors, and treatment for
  facial lipoatrophy and lipodystrophy (including
  boys) in children and adolescents
• Comparison of long-term ARV side effect profiles
  in international vs. US cohorts

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ICAB Scientific PrioritiesPrimary Therapy

• ICAB Representative Samantha Kuryla
• Top Priorities
• Simpler treatment regimens, including fixed-dose
  for children and alternative delivery methods
• Motivation for adherence and compliance   This
  will be a global issue among youth in boarding
  schools and other out of home situations
• Bidirectional effects of nutritional status on
  ARV response and ARV treatment on nutritional
  status

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ICAB Scientific PrioritiesPrimary Therapy

• Additional Priorities
• Development of cost-effective method of
  diagnosing HIV infection in infants in rural
  resource-limited settings
• Treatment interruption (scheduled and unplanned)
  relevant to US and international settings
• When to start HAART in children and the effects
  of not starting HAART in children and infants
  across age ranges (growth and development,
  cognitive, disease progression, etc.) 

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ICAB Scientific PrioritiesVaccine

• ICAB Representative Dawn English
• Top Priorities
• Treatment/therapeutic vaccines for children,
  adolescents, and pregnant women
• Preventive vaccines for mother-to-child
  transmission through breastfeeding
• Collaborate with HVTN for preventive vaccines for
  children and adults