Dr Barbara Castelnuovo

Uganda

EDCTP portfolio: Senior Fellowships

Dr Barbara Castelnuovo is setting up a cohort of older people living with HIV, to determine the health risks they face in later life.

Chronic conditions in older people living with HIV

The rollout of antiretroviral therapy has saved millions of lives. Increasingly, people living with HIV are surviving to old age.

Although these are very positive developments, older people are at increased risk of a range of non-communicable diseases, such as heart disease, respiratory disease and diabetes. In addition, these risks may be greater in people living with HIV, as HIV infections are associated with accelerated ageing, because of factors such as chronic inflammation and long-term exposure to antiretroviral drugs.

The challenge

Dr Barbara Castelnuovo has been based in Uganda for more than 10 years. She has established a range of cohorts monitoring people receiving antiretroviral therapy and exploring interactions between HIV and TB infections. Her work has identified a shift in health conditions affecting people living with HIV away from AIDS-related opportunistic infections towards non-communicable diseases.

In her EDCTP Senior Fellowship, Dr Castelnuovo is setting up a new cohort of older people (60 years of age or older) with HIV. Participants will undergo regular screening for high blood pressure, cardiovascular disease, respiratory function, kidney function and for a range of cancers. They will also undergo tests of physical function and be assessed for frailty and history of falls.

Dr Castelnuovo is also establishing a new group of clinicians and researchers with an interest in HIV and non-communicable diseases, which will meet regularly to share experiences and discuss cases. It will also link into an international network of experts and build stronger links with other stakeholders, including communities and policymakers.

The project

Dr Castelnuovo’s Senior Fellowship project will generate new data on a health issue of growing importance in sub-Saharan Africa – the co-morbidities experienced by older people with HIV who have been taking antiretroviral drugs for many years. The findings will have important implications for prevention of non-communicable disease in this group, as well as for the design of appropriate models of care that reflect the full range of their health conditions. The fellowship will also allow for the development of young clinicians and researchers in a field where there is limited expertise in Africa.

Impact


test the safety and efficacy of this new formulation in young children

Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

EDCTP portfolio: HIV & HIV-associated infections

The challenge

The rollout of antiretroviral therapy has saved millions of lives. Increasingly, people living with HIV are surviving to old age.

Although these are very positive developments, older people are at increased risk of a range of non-communicable diseases, such as heart disease, respiratory disease and diabetes. In addition, these risks may be greater in people living with HIV, as HIV infections are associated with accelerated ageing, because of factors such as chronic inflammation and long-term exposure to antiretroviral drugs.

Dr Barbara Castelnuovo has been based in Uganda for more than 10 years. She has established a range of cohorts monitoring people receiving antiretroviral therapy and exploring interactions between HIV and TB infections. Her work has identified a shift in health conditions affecting people living with HIV away from AIDS-related opportunistic infections towards non-communicable diseases.

In her EDCTP Senior Fellowship, Dr Castelnuovo is setting up a new cohort of older people (60 years of age or older) with HIV. Participants will undergo regular screening for high blood pressure, cardiovascular disease, respiratory function, kidney function and for a range of cancers. They will also undergo tests of physical function and be assessed for frailty and history of falls.

Dr Castelnuovo is also establishing a new group of clinicians and researchers with an interest in HIV and non-communicable diseases, which will meet regularly to share experiences and discuss cases. It will also link into an international network of experts and build stronger links with other stakeholders, including communities and policymakers.

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

Dr Castelnuovo’s Senior Fellowship project will generate new data on a health issue of growing importance in sub-Saharan Africa – the co-morbidities experienced by older people with HIV who have been taking antiretroviral drugs for many years. The findings will have important implications for prevention of non-communicable disease in this group, as well as for the design of appropriate models of care that reflect the full range of their health conditions. The fellowship will also allow for the development of young clinicians and researchers in a field where there is limited expertise in Africa.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact

L’homme RF et al. Nevirapine, stavudine and lamivudine pharmacokinetics in African children on paediatric fixed-dose combination tablets. AIDS. 2008;22(5):557–65.

Mulenga V et al. Abacavir, zidovudine, or stavudine as paediatric tablets for African HIVinfected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial. Lancet Infect Dis. 2016;16(2):169–79.

WHO. Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2010.

WHO. Consolidated guidelines on the use of antiretroviral drugs
for treating and preventing

HIV infection: Recommendations for a public health approach
(second edition). 2016

Projects: Children with HIV in Africa Pharmacokinetics and Adherence of Simple Antiretroviral Regimens (CHAPAS): CHAPAS-1 and -3

Project lead: Professor Chifumbe Chintu, University Teaching Hospital, Zambia (CHAPAS-1); Dr Veronica Mulenga, University Teaching Hospital, Zambia (CHAPAS-3)

Target population(s): Children with HIV

Sample size: 71 (CHAPAS-1); 480 (CHAPAS-3)

Countries involved: Ireland, the Netherlands, the UK, the USA, Zambia (CHAPAS-1); Uganda, Zambia (CHAPAS-3)

Project duration: 2005–2009 (CHAPAS-1); 2010 –2011 (CHAPAS-3)

EDCTP funding: €1.2M (CHAPAS-1); €4.6M (CHAPAS-3)

Total project funding: €1.2M (CHAPAS-1); €5.0M

About us

The European & Developing Countries Clinical Trials Partnership (EDCTP) is a public–public partnership between 14 European and 16 African countries, supported by the European Union. EDCTP’s vision is to reduce the individual, social and economic burden of poverty-related infectious diseases by affecting sub-Saharan Africa. EDCTP’s mission is to accelerate the development of new or improved medicinal products for the identification, treatment and prevention of infectious diseases, including emerging and re-emerging diseases, through pre- and postregistration clinical studies, with emphasis on phase II and III clinical trials. Our approach integrates conduct of research with development of African clinical research capacity and networking. The second EDCTP programme is implemented by the EDCTP Association supported under Horizon 2020, the European Union’s Framework Programme for Research and Innovation.

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