The clinical outcomes, response to treatment and epidemic dynamics of HIV-1 in the UK

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The characteristics of individuals with HIV in the UK are changing with a much greater number of those living with HIV being women. Treatments for HIV are now very effective and many people infected with the virus are able to live almost normal lives. As a result, not only is the HIV-infected population growing older, but many of the women are starting their own families. Even if these women do not yet require treatment for their own health, they may be treated for short periods of time to prevent their babies from becoming infected with HIV. This treatment is very effective and only a very small number of HIV-infected babies are now born in the UK each year. Treatment may be further complicated among individuals who are also infected with hepatitis C or B virus ? these individuals may require earlier treatment and/or different drug combinations than those who are only infected with HIV. Despite the benefits of treatment, the drugs may still occasionally fail in an individual. This may be because the individual develops side effects to the drugs, or that they find it difficult to take their drugs at exactly the same time every day. When treatments fail, the virus may become resistant to the drugs that the patient is receiving, and this may have knock-on effects for their future treatment choices. Consequently, doctors have started to change the way in which they treat HIV-infected people; for example, treatment may be started earlier and different drug combinations may be used which aim to reduce the risk of side effects, whilst minimising the risk that a patient?s virus will become resistant. In order to plan the future care for these individuals, we need to monitor the use of treatment in HIV-infected persons, and the outcomes of those who receive it. Two large ongoing studies in the UK, the UK CHIC Study and the UK HDRD, have been monitoring outcomes (e.g. use of treatment, AIDS events, deaths, development of resistance) in HIV-infected persons since 2001. This proposal requests funding to continue to expand and monitor these cohorts so that the information they provide remains timely and accurate. In addition to monitoring outcomes, we also plan to investigate whether treatment received during pregnancy has any long-term effects on the mother?s health, and whether infection with hepatitis B or C accelerates the progression of HIV disease, or reduces the benefits of treatments.