The EPIICAL story

11 May, 2022

In 2016 the Early-treated Perinatally HIV-infected individuals: Improving Children’s Actual Life (EPIICAL) consortium began gathering scientists and clinicians specialising in paediatric HIV to work towards establishing new, scientific efforts on the early treatment of HIV to improve the lives of children and ultimately lead to the remission of HIV in children.

The main focus of the consortium was the development of a predictive platform to inform treatment strategies that would lead to HIV remission. EPIICAL 2016-2020 succeeded in designing and conducting studies on paediatric HIV which led to the development of different, well-established cohorts of children living with HIV in Europe and Africa. These cohorts were intended for the evaluation of strategies to optimise the management of perinatally HIV-infected children. During the first phase of the project, the Child and Adolescent Reservoir Measurements on early suppressive ART (CARMA) study provided a lot of information about the immunological and virological features of early treated HIV child and adolescents on long term viral control. This data highlighted the impact of early-infant treatment on limiting the reservoir size also after a decade of suppressive therapy. Moreover in this cohort it was demonstrated that the early initiation of ART preserves the functionality of immune system.

In parallel, at this stage the consortium also established a large cohort of HIV infected infants treated before 3 months of age in limited-resource settings monitoring the clinical, virological and immunological features. These children were enrolled in Early Anti-Retroviral Treatment in HIV-infected Children (EARTH) study with the aim of providing important information on the characteristics associated with the establishment of HIV reservoirs.

EPIICAL’s success from 2016 to 2020 led to the development of the second phase of the project, Novel Strategies to induce long-term viral remission in Early Treated HIV infected Children. This phase, EPIICAL 2020-2024, aims to follow up on the established cohorts from the first phase. To do this and improve the management of these patients, the consortium developed a detailed retention strategy in the context of the BESST study, based on the analysis of adherence issues with children and adolescents on antiretrovirals. In these cohorts, thanks to the introduction of innovative methods, we are identifying novel immunological and virological endpoints.

The precious and informative data produced by the CARMA study inspired a new study, CARMA Global. This study will involve children seven years and older and youth infected with HIV who started ART in the first three months of life and remained in care while on ART. Participating children would have a viral load that is less than 50 copies per ml.

EPIICAL 2016-2020 succeeded in highlighting the strong possibility that early ART initiation plays a significant role in suppressing HIV. The high-quality data generated by the consortium is vital for improving the current understanding of HIV remission while paving the way to unravel the mechanisms behind viral remission. As we are now in the third year of EPIICAL 2020-2024, and there is currently no cure for HIV, we hope that the knowledge we generate will provide a clear picture of the evolution of HIV in early treated children and that will guide a new therapeutic intervention.

EPIICAL is sponsored by Penta and funded by ViiV Healthcare.