EPPICC is an international network of cohorts mainly from Eastern and Western Europe and also includes cohorts from outside of Europe like Thailand and South Africa. Participating studies identify important questions for epidemiological research on pregnant women living with HIV as well as their infants, children and adolescents with HIV and other infections such as hepatitis C and tuberculosis. Participating studies include multisite cohorts with national or regional coverage, single-site cohorts and surveillance studies.
European Pregnancy and Paediatric Infections Cohort Collaboration
EPPICC is a programme of work that mainly encompasses individual patient data meta-analysis and pharmacovigilance studies to assess the long-term safety and effectiveness of newly approved drugs for HIV infected women and children in routine care. The data from these cohort studies play a role in informing the design and feasibility of clinical trials and provide the means for the long-term follow-up of trial participants in routine care after the trial ends. The precursor to EPPICC was the European Infant Collaboration group, which, in 2009, was the first initiative to bring together data from multiple cohorts of children living with HIV in Europe. EPPICC began as part of EuroCoord, a European Commission FP7 programme funded Network of Excellence established in 2011 by the biggest HIV cohorts and collaborations within Europe: CASCADE, COHERE, EuroSIDA, and Penta, forming one pan-European network
Why is EPPICC needed?
The project combines and analyses data from all participating cohorts to answer questions about the risks and benefits of different diagnoses or treatment strategies. EPPICC also examines the long-term effects of HIV, TB, hepatitis, COVID-19 infection and treatment during pregnancy, childhood, and young adulthood, as well as regional variations in the risk and management of infections. By combining data from many cohorts, EPPICC is better able to answer questions that could not be addressed in a clinical trial or by one study because, for example, a large number of pregnant women or children are needed to answer the questions.
What questions is EPPICC trying to answer?
What is the uptake, safety, and effectiveness of new paediatric antiretroviral drugs such as dolutegravir among children and adolescents living with HIV in Europe
What are the long-term effects of lifelong HIV and long-term aentiretroviral treatment?
What is the cascade of care among children and adolescents living with HIV across Europe and how has this improved in recent calendar years?
What is the direct and indirect impact of the COVID-19 pandemic on children and adolescents living with HIV?
What are the characteristics of pregnant women living with HIV in Europe?
How are they cared for during pregnancy, childbirth and the period following delivery?
What antiretroviral drugs are used to treat HIV in pregnancy and are they safe?
What are the risks of adverse pregnancy outcomes in women with HIV, and what factors might increase or decrease these outcomes?
How are mothers living with HIV feeding their babies, and what are the risks of postnatal transmission in breastfed infants?
What has EPPICC told us so far?
EPPICC has shown that after starting antiretroviral therapy (ART), children and adolescents experience a low risk of disease progression to AIDS or death, though this risk is higher in children living in Eastern Europe and Thailand than in Western Europe. In addition to this, one-quarter of children/adolescents will switch from first to second-line therapy within 5 years of starting treatment.
We have also shown that growth and the risk of triple class failure of children and adolescents living with HIV is poorer among those who start treatment at an older age and that children and adolescents who experience treatment interruptions generally experience a good immune response when they restart treatment.
EPPICC has shown that the antiretroviral medication, Efavirenz is safe when used from the start of pregnancy, with no difference in the risk of birth defects compared with other antiretroviral regimens or no ART. We also discovered that severe haematologic toxicity, a decrease in bone marrow and blood cells, is rare in high-risk HIV-exposed infants receiving combination neonatal prophylaxis.
We have learnt that migrant women are more likely to be diagnosed with HIV later in pregnancy, but once ART is started, their virologic response is good and they are no more likely to have a detectable viral load at delivery than women starting treatment in pregnancy. Lastly, we have shown that TDF-containing NRTI backbones are not associated with an increased risk of adverse pregnancy outcomes (preterm delivery or small for gestational age infants) among women starting ART during pregnancy.
EPPICC is primarily funded by pharmaceutical companies for its drug safety and pharmacovigilance programme of work. It has also received funding from H2020 with REACH project and was part of the European Union’s Seventh Framework Programme for research, technological development and demonstration under EuroCoord grant agreement number 260694. The University College London (UCL) provides epidemiological coordination, manages the data pooling and conducts most of the analyses through the MRC Clinical Trials Unit for paediatrics, Great Ormond Street Institute of Child Health for pregnancy. Penta coordinates the network and its project operations.