Stellenbosch University
Welcome to Stellenbosch University
Prof Mark Cotton: Pioneer with a heart for children
Author: FMHS Marketing & Communication / FGGW Bemarking & Kommunikasie – Sue Segar
Published: 23/12/2021

A significant era will come to an end when Prof Mark Cotton retires at the end of the year, after a long and distinguished career as a global specialist in pediatric infectious diseases.

Cotton, distinguished Professor in Pediatrics, as well as Head of the Division of Pediatric Infectious Diseases in the Faculty of Medicine and Health Sciences, is an A-rated scientist, whose career saw him become a pioneer in the area of HIV. He was responsible for managing HIV-positive children from the very beginning of the HIV pandemic in South Africa and was also one of the first doctors to treat children with antiretroviral drugs (ARVs).

​Cotton established the Division of Pediatric Infectious Diseases at Tygerberg Children's Hospital in 1996 and became Director of the Children's Infectious Diseases Clinical Research Unit (KIDCRU) at the FMHS and Tygerberg Hospital in 2002. In 2013, the name changed to the Family Clinical Research Unit (FAMCRU) once adult HIV trials were incorporated, and later to the Family Centre for Research with Ubuntu. FAMCRU has satellite sites at Kraaifontein, Khayelitsha and Worcester and conducts research and clinical trials in adult and pediatric infectious diseases with a focus on HIV, TB, HIV/TB co-infection and common childhood infectious diseases.

Cotton has been involved in numerous clinical trials related to HIV, including the Children with HIV Early Antiretroviral (CHER) study, which changed the guidelines related to antiretrovirals.

Although he has reached the retirement age of 65, Cotton said he will be continuing with a number of significant research projects related to infectious diseases. “Most of them are trials of some sort – some big and some smaller," he said in an interview. He will remain Director of FAMCRU, but might consider relinquishing the position later next year.

“I do feel some sadness, because it is the end of something and now I am heading into a different phase. The one thing that is ending, is my clinical service," he said.  

However, he is happy that he will have more time to focus on his family. “We have a married son in Germany, who is expecting a son soon, and a daughter who is emigrating with her family to Australia at the end of the month. It is important for us to be there to support our children and grandchildren."

He is also considering writing a personal account of what it was like to be working in “a tough era", as well as working through, and possibly publishing, some of the writings of his late brother, Roy Joseph.

Cotton was born and raised in Goodwood in Cape Town's northern suburbs. His father, a pharmacist who wanted to be a doctor but could not afford it, inspired him to study medicine. Cotton matriculated from Settlers High School in Bellville and obtained his medical degree from the University of Cape Town. He subsequently obtained a PhD from Stellenbosch University.

Asked about his journey with children living with HIV, Cotton said there were some very poignant moments working with “little children being ravaged by the virus" and their families.

“We had some children that were real survivors and we got to know them. An abiding passion was to somehow obtain ARVs for these children.

“One of the terrible issues was when a child was really sick and needed to go to the ICU, but there were too few beds. There was lots of debate about whether they should go into ICU when there was no hope for them. We all took a terrible toll from that … but we really did everything we could for these kids."

A major highlight of his career was his involvement in the CHER trial. “It demonstrated the importance of identifying sick young infants quickly and starting treatment with ARVs early.

“We learnt so much about early treatment. It laid the groundwork for HIV remission research. In any such research, at some stage you must carefully withdraw ARVs. In the CHER trial, we successfully withdrew antiretrovirals in more than 200 children, who showed no ill effects over six years of observation.

“A key lesson from this trial was how we managed to bring out the collective goodness in people working on something important and working together. That is key in all our endeavors."

Elaborating on the work that still lies ahead, Cotton said FAMCRU is affiliated to a clinical trial network, the International Maternal Pediatric Adolescent AIDS Clinical Trial (IMPAACT) group, which is funded through the National Institute of Allergy and Infectious Diseases (NIAID) in the USA. “We have another seven years of funding to continue with trials for this network, many of which are for HIV. We are also doing a lot of other studies, including two TB vaccine studies in which I am involved.

“Another project is a therapeutic HIV vaccine study. It consists of a therapeutic vaccine that is given to a person with HIV to 'educate' the immune system, with the long-term goal of withdrawing ARV treatment and replacing it with better immunity. This study is in the early phase and it is an area in which we are very interested," Cotton said.

“On a personal level: Having started out working on HIV when it was in its awful, terrible early stage with no treatment and when it devastated children and families, as well as living through the rollout of treatment access and then refinement of treatment, I believe the next really important phase of research will be a focus on cure or remission.

“It is not going to be easy, but it could be achievable," Cotton concluded.