Meet the CIPHER grantees

Nelleke Langerak

Year awarded: 2013
Institution: University of Cape Town
Research site: South Africa
Primary mentor: A Graham Fieggen, University of Cape Town

Nelleke Langerak is a Human Movement Scientist, Physiotherapist and Biomedical Engineer. She works as a Neuroscience Fellow at the Division of Neurosurgery, University of Cape Town. Her special interest is in interdisciplinary long-term follow-up studies in people with childhood-onset neuromuscular disabilities.

More information on Nelleke | Email

“I’m still thrilled to see how this project grew … This CIPHER project has had a major influence on my life (work and personal), and I’m very grateful for that.”

Research project: HIV encephalopathy; the definition of the natural history, physical characteristics and imaging findings in a group of children with gait abnormalities

The issue

In children living with HIV, the virus can infect the central nervous system (CNS) during early stages of foetal brain development, which can lead to primary paediatric HIV-related CNS disorder, of which HIV encephalopathy (HIVE) is the most common clinical presentation. Clinicians noted that some children with HIVE present with pathological gait pattern and physical characteristics similar to those described in children with spastic diplegic cerebral palsy (CP). Dr Langerak conducted a pilot study to evaluate the pathological gait patterns and physical characteristics of children with HIVE and spastic diplegia, which led to a clear research question for her CIPHER project.

The CIPHER project

This project focused on children with HIVE and spastic diplegia in the Western Cape province of South Africa. The aim was to determine:

  • Clinical features between children with spastic diplegia and HIVE, children with spastic diplegia due to CP and typically developing children
  • Influence of ART initiation factors (age, CD count and viral load) on functional status
  • Whether encephalopathy and spastic diplegia seen in children with HIVE is static over time, despite ART.

As the project progressed, Dr Langerak added more studies, including functional assessments, upper limb tests, neurocognitive studies and more HIV-related investigations (adherence, blood results).

The impact

The research created better understanding of the functional status and neuropathological mechanisms behind HIVE, supporting the development of long-term treatment guidelines specific for children and adolescents with HIVE and spastic diplegia. Dr Langerak has received several awards, including:

  • The National Research Foundation (NRF) Research Career Award in 2014. The project proposal, in line with the CIPHER project, received funding for five years. It also resulted in a five-year contract with the University of Cape Town (UCT).
  • The Claude Leon Merit Award for Early-Career Researchers.
  • Competitive support for unrated researchers from the NRF. “I’m convinced that the success of my CIPHER grant had a positive influence on the reviewers’ judgement and award,” she says.

As a result of the project, she has supervised four Masters students and two postdocs.

Dr Langerak is one of the first four Mid-Career Neuroscience Fellows at the new Neuroscience Institute at UCT. “My interdisciplinary work – as emphasized through my CIPHER project – convinced the interview committee to take me on,” she explains. Linked to this, she hopes to be the mentor of a new CIPHER grantee soon.

1st International Paediatric HIV Symposium in Africa - Virtual Symposium 17-18 November 2021




Annual Impact Report 2020

CIPHER Grant Programme
Awards up to $150,000 to early-stage investigators to address critical research gaps in paediatric and adolescent HIV in resource-limited settings.

CIPHER Growing the Leaders of Tomorrow Fellowship
Provides support to young investigators in sub-Saharan Africa on priority research topics in paediatric and adolescent HIV clinical science.

CIPHER Global Cohort Collaboration
Brings together the largest collaboration of paediatric and adolescent HIV observational cohort networks to answer key questions of global public health.

Research agendas for paediatric and adolescent HIV