Dr. Gregory Wilson is co-principal investigator for the Vanderbilt HIV Vaccine Trials Program in Nashville, Tenn., a unit of the Fred Hutch-based HIV Vaccine Trials Network. The director of the Pediatric and Adolescent HIV Unit at Vanderbilt University Medical Center, he first encountered HIV as a pediatrician in training, treating HIV-infected infants.
My history with HIV goes back to my training in the late 1980s and early ’90s, when we started seeing infants in middle Tennessee infected through mother-to-child transmission. I was finishing up my residency and had chosen infectious diseases as my specialty, but I did not foresee my role in the HIV epidemic. Viral infections in general and HIV specifically became a specialty for me and a research interest also.
Treatment was just beginning to come out at that time. Adults had access to one or more medicines — first AZT, then other medications in that class. We didn’t yet have a lot of information on the medication’s effects on children.
From 1997 to 2006, we had a Pediatric AIDS Clinical Trials Unit here in collaboration with St. Jude’s Children’s Research Hospital [in Memphis]. That gave us access to medications. And it was a natural transition over to becoming an HIV vaccine trials unit.
You used to only be able to make an HIV diagnosis by following babies to 18 months of age. A baby born of an HIV-positive mother had antibodies for that long. With pediatric trial resources, we were able to make an earlier diagnosis. So we could concentrate our resources on those who needed them.
Mother-to-child transmission was the main route of infection, though children who were hemophiliacs were infected through blood products. By the late ’90s, we were beginning to see adolescents infected behavorially. If we had more access to schools and much more frank educational discussion about sex and risk factors, that could play a big role in preventing infection. Some schools do better than others.
As far as mother-to-child-transmission, we’ve really reduced that dramatically. In the U.S., it’s down to less than 1 percent. It’s now very rare.
What we’re seeing now are families who have adopted children from resource-limited areas like sub-Saharan Africa, so we’re seeing another wave of young children in our clinics. Like the infants before them, they go on medication and graduate from our clinics with the virus well controlled. We see waves of children graduating from clinic, going through elementary, middle, and high school, going to college.
Some of them come back to see us because they’ve stopped treatment, and we try to get them back into treatment. Some of those children are mothers now with children of their own. We see those children to make sure they’re not infected, and it’s a chance to see that their mothers stay on treatment.
We try to get them into our transition program and into adult care. If they fail, you just try to help them again. That’s the pediatric way.
Editor's note: Dr. Wilson talked about his early experiences treating HIV pediatric patients during a June 2017 interview for a story on the Vanderbilt unit's record enrollment in the HVTN AMP study.
