Cheryl Baxter

University of KwaZulu-Natal | ukzn · Centre for the AIDS Programme of Research in South Africa (CAPRISA)

Background and objective Saliva has been proposed as a potential more convenient, cost-effective, and easier sample for diagnosing SARS-CoV-2 infections, but there is limited knowledge of the impact of saliva volumes and stages of infection on its sensitivity and specificity. Methods In this study, we assessed the performance of SARS-CoV-2 testing...

Background Saliva has been proposed as a potential more convenient, cost-effective, and easier sample for diagnosing SARS-CoV-2 infections, but there is limited knowledge of the impact of saliva volumes and stages of infection on its sensitivity and specificity. Methods In this study, we evaluated the performance of SARS-CoV-2 testing in 171 saliv...

Background: Young women in sub-Saharan Africa continue to bear a high burden of HIV infection. Combination anti-HIV monoclonal antibodies are a potential HIV prevention technology that could overcome adherence challenges of daily oral pre-exposure prophylaxis. In this phase 1 clinical trial we aimed to determine the safety and pharmacokinetic prof...

Abstract Background South Africa has made significant progress in scaling up antiretroviral therapy (ART) to achieve the aspirational goal of HIV epidemic control. The aim of this study was to determine the prevalence of HIV, assess progress towards each of the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicators and determine factors ass...

Tenofovir-based pre-exposure prophylaxis (PrEP) revolutionized the global HIV prevention landscape. Prior to the proof-of concept trial in 2010, which demonstrated that tenofovir (TFV) could prevent sexual transmission of HIV, prevention options were largely limited to behavior change, condoms, and circumcision. Several subsequent studies evaluatin...

Introduction: Effective, long-acting prevention approaches are needed to reduce HIV incidence. We evaluated the safety and pharmacokinetics of VRC07-523LS and PGT121 administered subcutaneously alone and in combination as passive immunization for young women in South Africa. Methods: CAPRISA 012A was a randomised, double-blinded, placebo-control...

Introduction Young African women bear a disproportionately high risk for HIV acquisition. HIV technologies that empower women to protect themselves are needed. Safe, potent antiretroviral agents such as tenofovir alafenamide (TAF), formulated as long-acting subdermal implants, offer an innovative solution. Methods and analysis CAPRISA 018 is a pha...

Inflammatory cytokines augment humoral responses by stimulating antibody production and inducing class-switching. In women, genital inflammation (GI) significantly modifies HIV risk. However, the impact of GI on mucosal antibodies remains undefined. We investigated the impact of GI, pre-HIV infection, on antibody isotypes and IgG subclasses in the...

Salim Abdool Karim, Segenet Kelemu and Cheryl Baxter discuss COVID-19 impacts and adaptations in Africa.

This chapter traces the history of human immunodeficiency virus (HIV) from its origins, remarkable scientific advances, and unprecedented global responses through to the current state of the epidemic, progress towards ending acquired immunodeficiency syndrome (AIDS) and remaining challenges. It explains the origins of HIV-1 and HIV-2, the developme...

Inflammatory cytokines augment humoral responses by stimulating antibody production and inducing class-switching. In women, genital inflammation (GI) significantly modifies HIV risk. However, the impact of GI on mucosal antibodies remains undefined. We investigated the impact of GI, pre-HIV infection, on antibody isotypes and IgG subclasses in the...

Semen contains potent soluble proteins, bacteria, viruses, activated immune cells as well as anti- and pro-inflammatory cytokines that may influence the inflammatory response and alter microbial composition of the female genital tract. The presence of semen in the female genital mucosa may be a significant confounder that most studies have failed t...

Background The presence of semen in the vagina from unprotected sex may influence the immune and microbial environment of the female genital tract. Inflammatory cytokine concentrations and BV-associated bacteria in female genital secretions may influence HIV risk, although the effect of recent sexual intercourse on incident BV and the cytokine mili...

Introduction: New HIV prevention strategies are urgently required. The discovery of broadly neutralising antibodies (bNAbs) has provided the opportunity to evaluate passive immunisation as a potential prevention strategy and facilitate vaccine development. Since 2014, several bNAbs have been isolated from a clade C-infected South African donor, CA...

The RV144 HIV-vaccine trial highlighted the importance of envelope-specific non-neutralizing antibody (nNAb) Fc-mediated functions as immune correlates of reduced risk of infection. Since pre-exposure prophylaxis (PrEP) and HIV-vaccines are being used as a combination prevention strategy in at risk populations, the effects of PrEP on nNAb functions...

Passive immunisation with broadly neutralizing antibodies (bnAbs) is a promising approach to reduce the 1.7 million annual HIV infections globally. Early studies on bnAbs showed safety in humans, but short elimination half-lives and low potency and breadth. Since 2010, several new highly potent bnAbs have been assessed in clinical trials alone or i...

Human papillomavirus (HPV) infection correlates with higher rates of HIV acquisition, but the underlying biological mechanisms are unclear. Here we study associations between HPV and HIV acquisition and relate these to vaginal cytokine profiles in an observational cohort of women at high risk of HIV infection (CAPRISA 004, n = 779) and with 74% HPV...

Importance In Africa, the persistently high HIV incidence rate among young women is the major obstacle to achieving the goal of epidemic control. Objective To determine trends in coverage of HIV prevention and treatment programs and HIV incidence. Design, Setting, and Participants This cohort study consisted of 2 sequential, community-based longi...

Introduction: Tenofovir-containing oral pre-exposure prophylaxis (PrEP) is recommended for those at substantial risk as part of combination HIV prevention. However, there are limited data, beyond clinical trial settings, to guide the introduction of PrEP in healthcare services with adequate levels of adherence. Since young women in Africa are at h...

Introduction: Globally, sexually transmitted infections (STI) affect >300 million people annually, and are a major cause of sexual and reproductive health complications in women. In this commentary, we describe how STIs interact with the immune and non-immune cells, both within and below the cervicovaginal mucosal barrier, to cause inflammation, w...

Introduction Despite extensive prevention campaigns and scale-up of antiretroviral therapy, HIV incidence among young women in southern Africa remains high. While the development of an efficacious vaccine remains a challenge, the discovery of broadly neutralising monoclonal antibodies (mAbs) has created the opportunity to explore passive immunisati...

Intermittent use of a single antiretroviral agent in the presence of a replicating virus could potentially increase the development of antiviral resistance. The pericoital, before-and-after sex, dosing regimen used in the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 tenofovir gel trial meant that women who were infected w...

Introduction Young women in sub‐Saharan Africa are disproportionately affected by HIV, accounting for 25% of all new infections in 2017. Several behavioural and biological factors are known to impact a young woman's vulnerability for acquiring HIV. One key, but lesser understood, biological factor impacting vulnerability is the vaginal microbiome....

Genital inflammation significantly increases the risk for HIV infection. The seminal environment is enriched in pro-inflammatory cytokines and chemokines. Here, we investigated the interplay between semen cytokines and humoral immunity to understand whether the characteristics of semen antibodies are associated with genital inflammation. In 36 HIV-...

Purpose of review: HIV prevention approaches that women can use and control are a priority. Results from topical and oral preexposure prophylaxis (PrEP) HIV prevention trials have produced inconsistent results in women. One of the main behavioural factors impacting effectiveness of PrEP has been suboptimal adherence. In this review, we examine bio...

Background: We assessed whether women who acquired HIV during tenofovir gel prophylaxis trials can be safely and effectively treated with tenofovir-containing antiretroviral therapy (ART). Methods: Between May 2011 and October 2014, HIV seroconvertors from two tenofovir gel trials were recruited when eligible for ART (CD4 count <350 cells/μl, pr...

The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) has ensured that more infants in high-HIV burden countries survive childhood HIV-free. Although equal numbers of boy and girl children have survived to age 10, a gender divergence starts to emerge as they enter adolesce...

Although the Centre for the AIDS Programme of Research in South Africa (CAPRISA) was established in 2002, its mission and goal was informed by research undertaken by the founding members in the decade prior to its establishment. Population-based surveys undertaken between 1990 and 1992 highlighted the emerging but rapidly evolving HIV epidemic in S...

Women bear a disproportionate burden of the HIV epidemic in sub-Saharan Africa. Young women, including adolescent girls, unable to negotiate mutual faithfulness and/or condom use with their male partners are particularly vulnerable and have few HIV prevention options available to them that they can directly control. The development of technologies...

The HIV/AIDS epidemic in South Africa is amongst the worst in the world. As South Africa grappled with the exploding HIV epidemic in the 1990s, a group of South African AIDS researchers came together in 1996 to conduct basic science research on acute infection in seroconvertors from HIV prevention trials. This group, comprising epidemiologists, cli...

The key CAPRISA priorities when it was established was informed by studies understanding the evolving epidemic and included: i. Preventing HIV infection in young women; ii. Reducing AIDS related mortality due to HIV-TB interactions and iii. Enhancing knowledge of HIV-1 Clade pathogenesis. As can be gleaned from the previous chapters, CAPRISA has co...

Background: The incidence of HIV infection in young women in Africa is very high. We did a large-scale community-wide phylogenetic study to examine the underlying HIV transmission dynamics and the source and consequences of high rates of HIV infection in young women in South Africa. Methods: We did a cross-sectional household survey of randomly...

The 16 Days of Activism is an international awareness-raising campaign that promotes no violence against women and children. Each year the campaign runs between 25 November and 10 December and overlaps with World AIDS Day on 1 December. Adopted by South Africa (SA) in 1998, the campaign aims to raise awareness among South Africans about the negativ...

Although the number of new HIV infections has declined by over 30% in the past decade, the number of people who acquire HIV each year remains unacceptably high. In 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that there were about 2 million new HIV infections. The virus continues to spread, particularly in key populations,...

Each year thousands of adolescent girls and young women in South Africa (SA) become pregnant and many die from complications related to pregnancy and childbirth. Although women of all ages are susceptible, girls<15 years of age are five times as likely, and those aged 15 - 19 years twice as likely, to die from complications related to childbirth th...

Globally, herpes simplex virus type 2 (HSV-2) infection is the most common cause of genital ulcer disease. Effective prevention strategies for HSV-2 infection are needed to achieve the goals of the World Health Organization global strategy for the prevention and control of sexually transmitted infections. We assessed the effectiveness of pericoital...

Background: Women in Africa, especially young women, have very high human immunodeficiency virus (HIV) incidence rates that cannot be fully explained by behavioral risks. We investigated whether genital inflammation influenced HIV acquisition in this group. Methods: Twelve selected cytokines, including 9 inflammatory cytokines and chemokines (in...

Young women in sub-Saharan Africa bear a disproportionate HIV burden. They urgently require new HIV prevention approaches that they can use. This review provides an overview of the use of antiretrovirals for HIV preexposure prophylaxis (PrEP), highlighting some of the challenges with this technology and explores the potential role of mAbs for HIV p...

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial demonstrated a 39% reduction in HIV infection, with a 54% HIV reduction in women who used tenofovir gel consistently. A confirmatory trial is expected to report results in early 2015. In the interim, we have a unique window of opportunity to prepare for and devise eff...

Women bear a disproportionate burden of the HIV epidemic in sub-Saharan Africa and account for about 60% of all adults living with HIV in that region. Young women, including adolescent girls, unable to negotiate mutual faithfulness and/or condom use with their male partners are particularly vulnerable. In addition to the high HIV burden, women in A...

There is an urgent need for technologies to prevent sexual acquisition of HIV infection in young women in sub-Saharan Africa. After two decades of 11 pivotal trials of seven products, anti-retroviral-based topical microbicides are showing promise. Building on the CAPRISA 004 trial findings, several trials of new anti-viral agents, novel delivery me...

High adherence is key to microbicide effectiveness. Here we provide a description of adherence interventions and the adherence rates achieved in the CAPRISA 004 Tenofovir gel trial. Adherence support for the before-and-after dosing strategy (BAT 24) was provided at enrolment and at each monthly study visit. This initially comprised individual couns...

Since July 2010, there have been five clinical trials demonstrating the efficacy of antiretrovirals as treatment or oral/topical prophylaxis, in preventing HIV. One of the biggest challenges facing HIV prevention is how to translate these biomedical HIV prevention technologies with high adherence to achieve public health impact to turn the tide of...

Topical microbicides are an important, promising but complex HIV prevention technology under development. After 11 disappointing effectiveness trial outcomes of 6 candidate products (some tested as multiple doses and formulations) over the past 20 years, there is renewed optimism that a safe and effective microbicide will soon be available if the r...

Microbicides are an important HIV prevention technology under development, but the clinical testing of candidate products for efficacy faces many design and ethical challenges. Nevertheless, several microbicide candidates have been tested or are under development. Eight candidate products have entered late stage microbicide effectiveness trials. Fo...

Background: Tenofovir gel, used vaginally before and after coitus, reduced women's acquisition of HIV by 39%. This is a safety assessment of tenofovir gel, including renal, bone, gastrointestinal, genital and haematological parameters. Methods: In the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004, a double-blind, random...

The impetus for, and efforts in the past 20 years toward a women-initiated method for preventing sexual transmission of HIV has been previously well described. To date, four classes of topical agents categorized by mechanism of action as: surfactants, buffers, cell entry blockers and antiretroviral agents have undergone advanced clinical testing. T...

Purpose of review: Effective treatment exists for tuberculosis (TB) and for HIV, but treating both diseases simultaneously presents several challenges. This review assesses the evidence for the timing of antiretroviral therapy (ART) initiation in patients coinfected with TB. Recent findings: Published evidence clearly demonstrates that TB-HIV in...

Diagnosis and treatment of sexually transmitted infections (STIs) is a public health priority, particularly in regions where the incidence of human immunodeficiency virus (HIV) infection is high. In most developing countries, STIs are managed syndromically. We assessed the adequacy of syndromic diagnosis of STIs, compared with laboratory diagnosis...

Introduction: More than a million people acquire HIV infection annually. Pre-exposure prophylaxis (PrEP) using antiretrovirals is currently being investigated for HIV prevention. Oral and topical formulations of tenofovir have undergone preclinical and clinical testing to assess acceptability, safety and effectiveness in preventing HIV infection....

Human immunodeficiency virus (HIV) prevention tools that women can use and control are urgently needed. Microbicides are chemical products applied to the vagina or rectum to prevent the sexual transmission of HIV. Four classes of candidate microbicides have been tested to date: those that (1) enhance the natural defences in the vagina to inactivate...

We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculo...

Women who become pregnant during the conduct of biomedical human immunodeficiency virus prevention trials are taken off the study product for safety reasons. High pregnancy rates can compromise statistical integrity in these trials. The comprehensive contraceptive curriculum developed for the Centre for the AIDS Programme of Research in South Afric...

Young women in sub-Saharan Africa bear a disproportionate burden of HIV infection compared to men but have limited options to reduce their HIV risk. Microbicides could fill an important HIV prevention gap for sexually active women who are unable to successfully negotiate mutual monogamy or condom use. This paper describes the baseline sample charac...

Please cite this paper as: Moodley J, Pattinson R, Baxter C, Sibeko S, Abdool Karim Q. Strengthening HIV services for pregnant women: an opportunity to reduce maternal mortality rates in Southern Africa/sub‐Saharan Africa. BJOG 2011;118:219–225. Reliable data from South Africa emanating from WHO recommendations for the Safe Motherhood programme und...

Boulle et al. queried whether a clinical trial was needed to provide the evidence for the mortality benefits of antiretroviral therapy (ART) initiation during tuberculosis (TB) treatment. While several experts, including foremost TB-HIV scientists from South Africa and the USA, senior World Health Organization (WHO) and UNAIDS officials at the time...

The Centre for the AIDS Program of Research in South Africa (CAPRISA) 004 trial assessed the effectiveness and safety of a 1% vaginal gel formulation of tenofovir, a nucleotide reverse transcriptase inhibitor, for the prevention of HIV acquisition in women. A double-blind, randomized controlled trial was conducted comparing tenofovir gel (n = 445 w...

NO SINGLE STRATEGY OR TECHNOLOGY will be able to solve the AIDS pandemic. Rather, a host of prevention strategies such as behaviour change, voluntary counselling and testing, STI diagnosis and treatment, widespread access to male and female condoms, antiretroviral therapy, positive prevention as well as enhanced technologies like vaccines and micro...

AT PRESENT, AFRICA BEARS the brunt of the HIV epidemic. And it is southern Africa that has the highest burden of disease on the continent. In South Africa alone, by the end of 2007 around five million adults were living with HIV. That figure is growing. Every day several thousand people are estimated to become infected with the virus. The disease h...

Women account for approximately one-half of all human immunodeficiency virus (HIV) infections worldwide. Sexual transmission is the dominant mode of HIV transmission to women, and there is a concomitant associated epidemic of transmission to infants. The majority of HIV infections in women are in sub-Saharan Africa, with a disproportionate burden i...

The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with bot...

Although intravenous drug use is the major route of transmission in several countries, sexual transmission is the dominant mode of HIV spread globally, with a concomitant epidemic in infants borne to HIV-infected mothers. The HIV epidemic varies substantially from one geographic area to another, and three broad epidemic categories describe the dive...

This report summarises the discourse and recommendations emanating from the Southern and Eastern African (SEA) consultation that took place in Durban, South Africa from April 24th to 25th, 2005. It is intended to describe the views of workshop participants on issues raised during the course of the workshop, their recommendations on how these concer...