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2. Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI)

Author

Reece-Mills, Michelle, primary, Bodkyn, Curt, additional, Baxter, Jo-Anna B., additional, Allen, Upton, additional, Alexis, Cheryl, additional, Browne-Farmer, Chantelle, additional, Craig, Jenna, additional, de Young, Stephanie, additional, Denburg, Avram, additional, Dindial, Kevon, additional, Fleming-Carroll, Bonnie, additional, Gibson, Tracey, additional, Gupta, Sumit, additional, Knight-Madden, Jennifer, additional, Manley-Kucey, Margaret, additional, Mclean-Salmon, Sharon, additional, Ocho, Oscar Noel, additional, Orrigio, Kadine, additional, Read, Stanley, additional, Sin Quee, Corrine, additional, Smith, Brian, additional, Thame, Minerva, additional, Wharfe, Gilian, additional, Whitlock, James A., additional, Zlotkin, Stanley, additional, and Blanchette, Victor, additional

Published
2023
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3. Neurodevelopment of HIV-Exposed Uninfected Children Compared with HIV-Unexposed Uninfected Children during Early Childhood

Author

Young, Julia M., Bitnun, Ari, Read, Stanley E., and Smith, Mary Lou

Abstract

HIV-exposed uninfected (HEU) children during the preschool and early school ages may be at-risk for neurodevelopmental challenges due to in utero and perinatal exposure to HIV and/or antiretroviral (ARV) medications. HEU children and HIV-unexposed uninfected (HUU) children from the community were recruited and tested at 3 to 4 and 5 to 6 years of age. Demographic information, HIV/ARV exposure and measures of intelligence, visuomotor skills, and adaptive functioning were obtained. Nonparametric tests assessed group differences and multiple regression analyses adjusted for demographic variables. Additional multiple regression analyses were performed within the HEU group to investigate associations between neurodevelopmental measures and variables of HIV/ARV exposure. At 3 to 4 years, 211 HEU children and 31 HUU children were assessed, and 144 HEU children and 58 HUU children were assessed at 5 to 6 years of age. At 3 to 4 years of age, HEU children scored significantly lower on measures of Full-Scale IQ, Performance IQ, visual motor integration, and adaptive functioning. At 5 to 6 years of age, HEU children scored significantly lower on all neurodevelopmental measures. At both ages, children who were female and those with mothers who were employed achieved higher scores on measures intellectual ability and/or adaptive functioning. Within the HEU group, no consistent associations were found between neurodevelopmental measures and HIV/ARV specific variables. HEU children demonstrated significantly lower scores on neurodevelopmental measures than HUU children during early childhood. Gaps in verbal intellectual abilities were identified with age, highlighting the importance of monitoring neurodevelopment in this population over time.

Published
2022
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10. Canadian Pediatric & Perinatal HIV/AIDS Research Group consensus recommendations for infant feeding in the HIV context

Author

Khan, Sarah, Tsang, Kara K, Brophy, Jason, Kakkar, Fatima, Kennedy, V Logan, Boucoiran, Isabelle, Yudin, Mark H, Money, Deborah, Read, Stanley, and Bitnun, Ari

Subjects
Microbiology (medical), Infectious Diseases, Guideline
Abstract

Background: Providing comprehensive infant feeding guidance to families affected by HIV is complex and requires a multidisciplinary approach. While exclusive formula feeding remains the preferred recommendation for infants born to women living with HIV (WLWH) in high-income countries, a more nuanced approach that may include the option of breastfeeding under certain circumstances is emerging in many resource-rich countries. Methods: The Canadian Pediatric & Perinatal HIV/AIDS Research Group (CPARG) hosted a Canadian Institute of Health Research-funded meeting in 2016 to develop consensus among multidisciplinary providers around counselling and recommendations for infant feeding. After presentations by adult and paediatric health care providers, basic scientists, and community-based researchers, a subgroup drafted summary evidence-informed recommendations. Along with revisions among CPARG members, a community review was performed by a convenience sample of WLWH who had given birth in the past 5 years from Ontario and Quebec. A legal review was also conducted to ensure understanding of the criminalization potential and concern of HIV transmission and exposure. Results: The Canadian consensus guidelines continue to support formula feeding as the preferred method of infant feeding as it eliminates any residual risk of postnatal vertical transmission. Formula should be made available for all infants born to mothers living with HIV for their first year of life. A comprehensive approach to counselling WLWH is outlined to assist providers to effectively counsel on current evidence to ensure WLWH are fully informed in their decision making. For women meeting criteria to and elect to breastfeed, frequent maternal virologic monitoring and follow-up is required of both mother and infant. Antiretroviral prophylaxis and monitoring are recommended for breastfed infants. The community review highlighted the importance of other supports and counselling needed for implementing effective formula feeding, aside from access to formula. The legal review provided clarifying language around child protection services involvement and the need to provide referral to legal resources or information upon request. Surveillance systems to monitor for cases of breastmilk transmission should be in place to improve gaps in care and develop further knowledge in this area. Conclusion: The Canadian infant feeding consensus guideline is designed to inform and enable better care for WLWH and their babies. Ongoing evaluation of these guidelines as new evidence emerges will be important.

Published
2023

12. Attention and neurodevelopment in young children who are HIV-exposed uninfected.

Author

Young, Julia M., Chen, Vanessa, Bitnun, Ari, Read, Stanley E., and Smith, Mary Lou

Subjects
EDUCATION of mothers, HIV infections, MULTIPLE regression analysis, DEVELOPMENTAL disabilities, NEURAL development, ATTENTION, INFECTIOUS disease transmission, INTELLECT, EMPLOYMENT, RESEARCH funding, CHILDREN
Abstract

Children HIV-exposed, uninfected (CHEU) are at risk for compromised developmental outcomes. Attention is important for behavioural, cognitive and academic skills, yet has not been thoroughly investigated compared to children HIV-unexposed uninfected (CHUU). Fifty-five CHEU and 51 CHUU children were recruited at 5.5 years of age. Measures of inattention (IA), hyperactivity/impulsivity (HI) and total scores were collected using the parent-reported ADHD-Rating-Scale-IV. Measures of intelligence, visuomotor skills, academics and adaptive functioning were obtained. Analyses of between-group differences were performed as were correlational and multiple regression models, accounting for maternal education, employment and delivery type. Few children met clinical cut-offs for probable ADHD (3.6% CHEU, 2.0% CHUU), and no group differences in measures of IA, HI and combined scores were found. CHEU scored significantly lower than CHUU on intelligence, visuomotor function, academic skills and aspects of adaptive behaviour, though within age expectations. Lower Full-Scale IQ and Processing Speed were associated with higher IA in CHEU and lower adaptive functioning with higher IA in CHUU. Across both groups, children of unemployed mothers had more HI symptoms. CHEU were not at increased risk for attention difficulties at 5.5 years of age. Maternal employment status highlights the contribution of sociodemographic factors in shaping behaviour and neurodevelopment. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Challenges to achieving and maintaining viral suppression among children living with HIV

Author

Kakkar, Fatima, primary, Lee, Terry, additional, Hawkes, Michael T., additional, Brophy, Jason, additional, Lindy, Samson, additional, Singer, Joel, additional, Dieumegard, Hinatea, additional, Sauve, Laura, additional, Alimenti, Ariane, additional, Vaudry, Wendy, additional, Seigel, Sandra, additional, Tan, Ben, additional, Karatzios, Christos, additional, Lamarre, Valerie, additional, Read, Stanley, additional, Soudeyns, Hugo, additional, and Bitnun, Ari, additional

Published
2020
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20. THE CIHR CANADIAN HIV TRIALS NETWORK (CTN) POSTDOCTORAL FELLOWSHIP AWARDS PROGRAM (PFAP): A MODEL FOR TRAINING AND RETAINING YOUNG CLINICAL SCIENTISTS

Author

Sas, Jacqueline, primary, Harris, Marianne, additional, Chen, Adrienne, additional, Hawkes, Michael, additional, Kaul, Rupert, additional, Osborne, Chuck, additional, Read, Stanley, additional, Pendergraft, Kevin, additional, Westland, Kristin, additional, Cormier, Renée, additional, Sinden, Sean, additional, and Anis, Aslam, additional

Published
2018
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21. Immunogenicity and Safety of the Quadrivalent Human Papillomavirus Vaccine in Girls Living With HIV

Author

Brophy, Jason, primary, Bitnun, Ari, additional, Alimenti, Ariane, additional, Lapointe, Normand, additional, Samson, Lindy, additional, Read, Stanley, additional, Karatzios, Christos, additional, Dobson, Simon, additional, Moses, Erin, additional, Blitz, Sandra, additional, Lipsky, Nancy-Grace, additional, Ogilvie, Gina, additional, Walmsley, Sharon, additional, Raboud, Janet, additional, and Money, Deborah, additional

Published
2018
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30. Video directly observed therapy to improve adherence of human immunodeficiency virus infected adolescents to combination antiretroviral therapy: a proof-of-concept study.

Author

Kordy, Faisal, Nashid, Nancy, Khan, Sarah, Read, Stanley, Macdougall, Georgina, Louch, Debra, Arneson, Cheryl, and Bitnun, Ari

Subjects
HIV infections, HIV-positive persons, PILOT projects, DIRECTLY observed therapy, COMBINATION drug therapy, VIRAL load, VIDEOCONFERENCING, ANTIRETROVIRAL agents, PATIENT satisfaction, QUALITY assurance, DRUGS, QUESTIONNAIRES, PATIENT compliance, TEXT messages, LONGITUDINAL method, THERAPEUTICS, ADOLESCENCE
Abstract

Adherence to antiretroviral therapy (ART) is a major challenge for many youth living with HIV (YLWH). In this prospective proof-of-concept study, we assessed the feasibility and acceptability of conducting a study of video directly observed therapy (VDOT) as a method of improving medication adherence in YLWH who had a history of poor adherence to ART. The study had four phases; phase I – VDOT daily (4 months) using Facetime®; phase II – daily texting (2 months); phase III – weekly texting (3 months); phase IV – no intervention (3 months). Participants were seen in clinic on a monthly basis for assessment and laboratory evaluation. Five of eight eligible participants were enrolled. All achieved virologic suppression one month after enrollment. Three of five completed the study protocol and maintained virologic suppression through the 12-month period of study. Participant responses to the end-of-study questionnaire indicated satisfaction with the intervention and thought VDOT was helpful to them. Healthcare providers thought that the intervention was effective for some youth but was at times burdensome. This proof-of-concept study demonstrated that VDOT may be effective at improving medication adherence in previously poorly adherent YLWH and that larger studies of VDOT for such patients are both feasible and warranted. [ABSTRACT FROM AUTHOR]

Published
2023
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34. Nevirapine Pharmacokinetics and Safety in Neonates Receiving Combination Antiretroviral Therapy for Prevention of Vertical HIV Transmission

Author

Lau, Elaine, primary, Brophy, Jason, additional, Samson, Lindy, additional, Kakkar, Fatima, additional, Campbell, Douglas M., additional, Yudin, Mark H., additional, Murphy, Kellie, additional, Seto, Winnie, additional, Colantonio, David, additional, Read, Stanley E., additional, and Bitnun, Ari, additional

Published
2017
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36. Chitinase-3-like Protein 1 Is Associated with Poor Virologic Control and Immune Activation in Children Living with HIV.

Author

Bernard, Isabelle, Ransy, Doris G., Brophy, Jason, Kakkar, Fatima, Bitnun, Ari, Samson, Lindy, Read, Stanley, Soudeyns, Hugo, and Hawkes, Michael T.

Subjects
HIV-positive children, ENZYME-linked immunosorbent assay, VIRAL load, MICROBIAL enzymes, HIV, PROTEINS, NEUTROPHILS
Abstract

Perinatally infected children living with HIV (CLWH) face lifelong infection and associated inflammatory injury. Chitinase-like 3 protein-1 (CHI3L1) is expressed by activated neutrophils and may be a clinically informative marker of systemic inflammation in CLWH. We conducted a multi-centre, cross-sectional study of CLWH, enrolled in the Early Pediatric Initiation Canadian Child Cure Cohort Study (EPIC4). Plasma levels of CHI3L1, pro-inflammatory cytokines, and markers of microbial translocation were measured by enzyme-linked immunosorbent assays. Longitudinal clinical characteristics (viral load, neutrophil count, CD4+ and CD8+ T-lymphocyte counts, and antiretroviral (ARV) regimen) were abstracted from patient medical records. One-hundred-and-five (105) CLWH (median age 13 years, 62% female) were included in the study. Seventy-seven (81%) had viral suppression on combination antiviral therapy (cART). The median CHI3L1 level was 25 μg/L (IQR 19–39). CHI3L1 was directly correlated with neutrophil count (ρ = 0.22, p = 0.023) and inversely correlated with CD4/CD8 lymphocyte ratio (ρ = −0.35, p = 0.00040). Children with detectable viral load had higher levels of CHI3L1 (40 μg/L (interquartile range, IQR 33–44) versus 24 μg/L (IQR 19–35), p = 0.0047). CHI3L1 levels were also correlated with markers of microbial translocation soluble CD14 (ρ = 0.26, p = 0.010) and lipopolysaccharide-binding protein (ρ = 0.23, p = 0.023). We did not detect differences in CHI3L1 between different cART regimens. High levels of neutrophil activation marker CHI3L1 are associated with poor virologic control, immune dysregulation, and microbial translocation in CLWH on cART. [ABSTRACT FROM AUTHOR]

Published
2022
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40. The genetic diversity of Epstein-Barr virus in the setting of transplantation relative to non-transplant settings: A feasibility study

Author

Allen, Upton D., primary, Hu, Pingzhao, additional, Pereira, Sergio L., additional, Robinson, Joan L., additional, Paton, Tara A., additional, Beyene, Joseph, additional, Khodai-Booran, Nasser, additional, Dipchand, Anne, additional, Hébert, Diane, additional, Ng, Vicky, additional, Nalpathamkalam, Thomas, additional, and Read, Stanley, additional

Published
2015
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42. The HIV Continuum of Care in the Bahamas in 2012

Author

Forbes, Nikkiah, primary, Johnson, Glenise, additional, Frankson, Morton Anthony C., additional, Johnston, Kathy, additional, Martin, Indira, additional, Smith, Andrica, additional, Mcconnell, Keith, additional, Sands, Rochelle, additional, Garrison, Audene, additional, Weissman, Sharon, additional, Thompson, Tamara, additional, and Read, Stanley, additional

Published
2015
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