In Europe and North America, prognosis for persons with HIV (PWHIV) has improved since the introduction of combined antiretroviral in 1996[1]. There has been considerable research into prognosis for PWHIV, especially for people that acquired HIV sexually[1-3]. However, there has been much less research, particularly in recent years when mortality rates among PWHIV have been lower[1], into prognosis for subgroups of adults that acquired HIV through other routes, for example, injecting drug use, and, particularly, through blood transfusions and mother-to-child (vertical) transmission. The number of people that acquired HIV through these routes is much lower than those that acquired HIV sexually, so individual cohorts lack the statistical power to look at morbidity and mortality outcomes for these groups. Therefore, collaborations between cohorts of PWHIV are the best way to quantify prognosis for these less-studied subgroups. PWHIV in these less-studied groups will want to know about their prognosis, rather than relying on estimates produced for PWHIV that acquired HIV sexually. Additionally, previous research from France found that within those that acquired HIV sexually, there were differences in mortality according to gender and region of origin[4], but further study is required to replicate these findings in other settings and acquisition route groups.
Aims and objectives
The aim is to quantify prognosis for groups of PWHIV according to probable route of acquisition. In particular, the PhD will focus on those that acquired HIV through injecting drug use, blood transfusions, and vertical transmission, and will compare prognosis for these groups in the current era of antiretroviral therapy to those that acquired HIV sexually (work theme 1). An additional aim is to assess whether differences by region of origin exist within HIV acquisition groups, including through sexual transmission (work theme 2).
Methodology
The student will start with a review of the literature on prognosis for PWHIV that acquired HIV sexually, through IDU, blood transfusions, and via mother-to-child transmission. For both work themes, the student will utilise epidemiological techniques to quantify and compare prognosis, particularly survival analysis, and regression models, for example, Cox and Poisson regression models. Prognosis will be defined in terms of various outcomes including mortality, time to viral suppression, and AIDS events. Data for this PhD would come from the Antiretroviral Therapy Cohort Collaboration (ART-CC). The ART-CC is a collaboration of HIV cohorts, managed by the University of Bristol (http://www.bristol.ac.uk/art-cc/), that has data available on >200,000 adult PWHIV in Europe and North America with follow-up after 2010. The ART-CC has sufficient power to study people that acquired HIV through IDU, blood transfusions, and mother-to-child transmission, as well as sexually. The PhD would provide cutting-edge training in epidemiological and statistical modelling and would give the opportunity to present findings at international infectious disease conferences, and to use the supervisory group’s links to liaise with HIV policy makers.
Apply for this project
This project will be based in Bristol Medical School - Population Health Sciences.
Please contact [Email Address Removed] for further details on how to apply.
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