The PHACS Scientific Leadership Group created seven working groups in 2008. The working groups are responsible for close examination of the data in their domain. They are also responsible for the development of abstracts for presentation and manuscript publication. Click below for a description of each Working Group, contact information for the Chair(s), and a link to its published research.
Adolescents and Young Adults Working Group
Chair: Claude Mellins, PhD, Professor of Clinical Psychology, Columbia University
Chair: Barbara Moscicki, MD, Professor of Pediatrics, University of California Los Angeles
Chair: Katherine Tassiopoulos, DSc, Senior Research Scientist, Harvard T. H. Chan School of Public Health
The primary aims of the Adolescent, Risk Behaviors, HPV and Other STDs Working Group are to examine behaviors including sexual activity, substance use and adherence in youth perinatally-exposed to HIV, and the factors associated with these behaviors; and to examine sexually transmitted infections, reproductive health outcomes including pregnancy, and the transition to adult functioning, and – for HIV-infected youth – adult health care as our participants become young adults. Our group focuses its work on both the AMP and SMARTT protocols of PHACS. Examples of analyses that our working group has already undertaken include examining the co-occurrence of sexual, substance use, and mental health behavior risks in perinatally HIV-infected and exposed, uninfected youth; the prevalence of sexual activity among HIV-infected youth and factors associated with initiating sexual activity and with unprotected sex; the agreement between self-reported measures of antiretroviral treatment adherence and HIV RNA viral load; and substance use among perinatally HIV-infected and exposed, uninfected youth.
Cardiopulmonary Working Group
Chair: Paige Williams, PhD, Senior Statistician, Harvard T. H. Chan School of Public Health
Chair: Steven Lipshultz, MD, Chair of Pediatrics, Wayne State University School of Medicine
The primary aims of the Cardiopulmonary Working Group (CPWG) are (1) to evaluate the effects of HIV and antiretroviral (ARV) treatment on cardiac and pulmonary function in children and adolescents with perinatally-acquired HIV infection or perinatally-exposed to HIV but uninfected, and (2) to evaluate the safety of ARV treatment given to HIV-infected pregnant women on cardiac and pulmonary health of their children. The CPWG is comprised of 10-20 experts in cardiology, pulmonary medicine, immunology, pediatrics, biostatistics, and epidemiology.
Some of the past projects include evaluation of serum biomarkers of cardiac function in HIV-exposed uninfected (HEU) children, echocardiographic measures of cardiovascular function and structure, and pulmonary function tests of HIV-infected and HEU children. In terms of cardiovascular objectives, we have evaluated predictors of elevated cardiac biomarkers (such as C-reactive protein), and demonstrated associations of these biomarkers with echocardiographic measures among HEU children in the SMARTT study. We have also shown that HIV-infected children have marked improvement in cardiac functioning based on echocardiographic measures as compared to HIV+ cohorts studied earlier in the HIV epidemic, but still show some differences from HEU children of similar ages in the PHACS AMP study. In terms of pulmonary functioning, members of this working group demonstrated an increased risk of asthma in the HIV+ children in AMP as compared to the HEU controls. This finding stimulated a subgroup of this working group to initiate a separate PHACS substudy, the Ancillary Pulmonary Complication of HIV Infection study, which has conducted pulmonary function testing on a subset of AMP participants in order to better understand the role of HIV in asthma and other pulmonary diseases.
The Cardiopulmonary Working Group has also coordinated with other working groups to participate in specific concepts with overlapping interests. For example, the WG collaborated with the Metabolic, Nutrition, and Growth Working Group on an analysis of cardiac risk factors in adolescents aged 15 or older, based on risk prediction models. The creation of a DNA library on PHACS subjects also was strongly endorsed by the Cardiopulmonary Working Group.
New directions of future research include proposals to evaluate the relationship of echocardiogram parameters among children in the AMP study with both cardiac biomarkers and vitamin D. In addition, there is great interest in studying the genotype of HIV+ and HEU children in the PHACS AMP studies to better understand whether certain mutations may predispose patients to cardiovascular or pulmonary complications. These proposed genetic studies will take the PHACS program well into the next era of HIV medicine, namely the role of genetics in diagnosis and management of HIV infection in children, adolescents, and young adults.
The Cardiopulmonary Working Group collected research data on numerous measurements pertinent to its special interests in areas of cardiology, pulmonology, immunology, and genetics. The measurements includes data from echocardiography, pulse oximetry, pulmonary function testing, carbon monoxide diffusion studies in lung tissue, immunological tests of structure and function of peripheral blood, T, B, NK, and monocytes, and DNA sequencing. Statistical analysis is provided by the Harvard School of Public Health.
Complications Working Group
Chair: Kunjal Patel, DSc, Research Scientist, Harvard T. H. Chan School of Public Health
Chair: Russell Van Dyke, MD, PHACS Principal Investigator, PHACS Coordinating Center, Tulane University
The primary aim of the Complications working group is to identify infectious and non-infectious complications of HIV disease and evaluate their associations with antiretroviral therapy. Our working group therefore focuses its work on the AMP protocol of PHACS which includes perinatally HIV-infected youth and a comparison group of perinatally HIV-exposed but uninfected children and adolescents. Examples of our working group activities include examining trends in antiretroviral drug use, CD4 counts, HIV viral loads, and diagnoses; evaluating long-term treatment management strategies in the context of antiretroviral treatment failure, drug resistance and HIV tropism; comparing the effectiveness of vaccines for measles, mumps, rubella, varicella, and human papillomavirus among infected and uninfected youth and identifying correlates of effective immune responses; examining the relationship between tenofovir use and renal disease; estimating the prevalence of liver disease; examining oral health including the prevalence of dental caries and periodontal disease; identifying biomarkers of low proviral load to inform future cure and therapeutic vaccine strategies; and establishing a DNA repository for genomic studies. Our working group has also collaborated with international pediatric cohorts to answer research questions relevant to the global perinatal HIV-epidemic.
Hearing and Language Working Group
Chair: Mabel Rice, PhD, Distinguished Professor, Child Language Doctoral Program, University of Kansas
Chair: Peter Torre, PhD, Associate Professor, School of Speech, Language, and Hearing Science, San Diego State University
Chair: Tzy-Jyun Yao, PhD, Senior Statistician, Harvard T. H. Chan School of Public Health
The Hearing/Language Working Group is a team of hearing scientists, speech/language pathologists, pediatricians, psychologists, epidemiologists and statisticians whose main goal is to examine the effects of HIV and/or antiretroviral medications (ARVs) on hearing and/or language acquisition in youth who were exposed to HIV or infected perinatally. Examples of our working group activities include investigations of hearing mechanisms, investigations of language acquisition in infants and toddlers, risk for and consistency of language impairments in school-aged children, and the persistence of language impairments into adulthood. We are interested in the safety of ART treatment and the role of possible environmental effects on hearing and language abilities.
Maternal Exposures Working Group
Chair: Ellen Chadwick, MD, PHACS Principal Investigator, Ann & Robert H. Lurie Children's Hospital of Chicago
Chair: Deborah Kacanek, ScD, Social Epidemiologist, Harvard T. H. Chan School of Public Health
The Maternal Exposure Working Group is charged with examining factors and events that occur during pregnancy that may affect the baby. We are examining pregnancy outcomes such as the length of the pregnancy, the size of the newborn, the type of delivery required (Cesarean section or vaginal delivery), the occurrence of subtle or major congenital defects, and any unusual events that happened in the newborn or later in life. We then see if the outcomes are associated with any specific findings or events during the pregnancy such as the use of specific antiretroviral drugs, smoking or alcohol use, severity of the mother’s HIV disease, and so on. From these studies, we can see if any of the events lead to problems in the baby. We have also examined how the use of antiretroviral drugs has changed over the years as new drugs were discovered and older ones were dropped. We developed a technique to look at the amount of the antiretroviral drugs that cross the placenta and into the fetus by examining their presence in meconium (the first stools produced by the newborn). Finally, we are doing studies to determine whether events that happen in pregnancy affect the genetic system of the body (epigenetic studies) and the energy system of the cells (mitochondrial DNA function). From these studies, we will identify how frequently adverse outcomes occur and develop an understanding of why they happen so we can reduce their occurrence.
Neurodevelopmental and Neurology Working Group
Chair: Kay Malee, PhD, Psychologist, Ann & Robert H. Lurie Children's Hospital of Chicago
Chair: Renee Smith, PhD, Pediatric Research Psychologist, University of Illinois at Chicago
Chair: Katherine Tassiopoulos, DSc, Senior Research Scientist, Harvard T. H. Chan School of Public Health
The Neurodevelopmental and Neurology Working Group is a team of psychologists, psychiatrists, neurologists, pediatricians, epidemiologists and statisticians whose main goal is to examine the neurodevelopmental and neurological effects of HIV and/or antiretroviral medications (ARTs) on youth who were exposed or infected perinatally. We examine the potential short- and long-term consequences of exposure to or infection with HIV and its treatment on cognition, academic achievement, and on the neurological, emotional, and behavioral development of youth over time. We also examine how the environment and other possible stressors and/or protectors contribute to all of these developmental outcomes.
Nutrition, Growth, and Metabolism Working Group
Chair: Denise Jacobson, PhD, Senior Research Scientist, Harvard T. H. Chan School of Public Health
Chair: Jennifer Jao, MD, MPH, Associate Professor of Pediatrics, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago
We are studying the effects of HIV and antiretroviral medications on nutrition, growth and metabolism in HIV-infected and HIV-exposed but uninfected children, adolescents and young adults over time. We are specifically interested in the distribution of body in different body areas, pre-diabetes and diabetes, blood lipid abnormalities, risk for cardiovascular disease, acquisition of bone mass, timing of pubertal development and mitochondrial abnormalities.