HIV Research

The Division provides medical services to a population of children and adolescents with HIV infection, most infections in the past were acquired as a result of mother to child transmission, and recently sexually transmitted infections have become more frequent. This population provides the foundation for our local studies of the epidemiology, treatment and pathogenesis of HIV. One area of study is practice improvement wherein the structure and functioning of our medical care delivery system is evaluated and as evidence-based findings support, changed to ensure the provision of optimal care. Recently studies have demonstrated that measurements of the level of activation of the immune system (measured as CD38+CD8+ T-cells) correspond to patients whose HIV disease will more rapidly progress. Studies are underway to follow activation and to determine if it can be controlled and reduced.

We also follow the epidemiology of HIV infections. Recent studies have included demonstrations of transmission of HPV virus (human papillomavirus) from HIV infected mothers to their newborns, identified in Houston at a higher rate of HIV transmission from HIV infected mothers to their newborns compared to the US average and demonstrated that current antiretroviral treatments allow infected children to reach puberty in parallel with their HIV free peers. This was not the case in the recent past. We have, however, also documented that our HIV infected population has retarded growth as compared to their peers and are now investigating reasons for this finding.

Because children with HIV infection respond differently to childhood vaccinations than do HIV free children, we have a broad group of studies directed to learning how vaccinations must be changed to best insure durable immunity for HIV infected individuals. These studies focus on all pediatric vaccinations with focused efforts directed to HPV, hepatitis-B, and flu vaccines.

In parallel with the studies of vaccines which measure the overall capacity of a child’s immune system to respond to an infectious agent, we also make targeted studies of specific immunological mechanisms in attempts to understand the mechanistic reason for deficient immune responses. Current studies focus on impaired maturation of the immunological cells that make antibodies (B-cells), FoxP3 positive T-cells (a cell type associated with the regulation of immune responsiveness), CD31 positive T-cells (a cell type that can reflect the function of the thymus) and on the integrity of the intestinal lining (deficient immune responsiveness is associated with chronic activation of the immune system; this in turn is in part a result of damage to the gut caused by HIV infection).