Keywords: HIV, AIDS, cohort collaboration, multidisciplinary, Network of Excellence, research, training, antiretroviral therapy, prediction models, migrants, tuberculosis, hepatitis, incidence, surveillance
Over the past 15 years, some of the biggest HIV cohorts and collaborations - CASCADE, COHERE, EuroSIDA and PENTA - have played a central role in developing our understanding of HIV progression and the effects of antiretroviral therapy, enabling European expertise to contribute directly to the advances in patient diagnosis and management of HIV worldwide, while providing a continued surveillance mechanism for the detection of emerging problems at a European level. Together, these collaborations form the foundation of a Network of Excellence called EuroCoord.
EuroCoord currently has access to data from over 250,000 HIV-infected children and adults across the European continent and beyond, both male and female, infected through sex between men, sex between men and women, injecting drug use, hospital-acquired and from mother to child, with and without co-infection with hepatitis viruses, of different ethnic and socio-economic backgrounds, from indigenous and migrant populations, and in settings with varying levels of access to care and laboratory techniques. The multidisciplinary research undertaken by the network will address key areas aimed at improving the management and life of HIV-infected individuals, whilst allowing differences within sub-groups to be explored.
EuroCoord is in a position to mobilise European HIV cohort research, bringing it within one truly Europe-wide network of cohort studies with a strong and increasing presence in the Central- and Eastern European region. The structure of this large, integrated network ensures that the most competitive science is performed whilst allowing expertise and resources to be pooled. This in turn allows new initiatives to be undertaken within an integrated collaborative structure.
There are currently over 1.5 million people across Europe infected with HIV with an estimated 100,000 newly infected in 2007 alone. Combination antiretroviral therapy (cART) has dramatically improved outcome for infected individuals who live in countries that allow them access to it. Although life expectancy has improved in Western Europe and elsewhere in industrialised countries, it is still not comparable to that of their uninfected counterparts. cART is not a cure and once initiated must be taken for life.
Given the potential for therapy failure due to difficulties with adherence, the emergence of resistance, and the development of adverse drug reactions as a result of long-term antiretroviral exposure, disease progression during treatment remains highly variable and it is uncertain whether further improvements are possible. Furthermore, there could be changes in the circulating virus which impact on the rate of disease progression and response to treatment. An ongoing monitoring mechanism to assess changes in viral characteristics in targeted ways is crucial as is a continual assessment of any impact such changes may have on the long-term outcome of infected people.
Access to care varies tremendously across the European continent. cART remains expensive (over 5000 Euro per patient per year) and is not universally and continuously available to all infected people in every country. Even when available, the essential tools for patient management, such as CD4 monitoring and viral load and resistance testing, are not necessarily accessible. With the challenges compounded by an epidemic of multi-drug resistant tuberculosis and high rates of hepatitis B and C, there is no place for complacency within the HIV research agenda in Europe and the efforts made to date to improve patients' outcome in Western Europe need to be sustained and also expanded to encompass all European citizens.
The structure of EuroCoord ensures that standardised methods and protocols are employed and common research goals and strategies realised and duplication of work avoided. This means that the NoE will be in an even better position to continue to contribute evidence for treatment guidelines, wherever possible, and to develop white papers and reports on characteristics of the European HIV-infected population, pathogenesis of HIV, impact of management strategies and treatment of sub-groups of patients, including those with TB and HBV/HCV coinfection, as well as develop prediction models. Likewise, EuroCoord will expand on the standardisation efforts on how best to conduct clinical research. The NoE, based on the previous expertise and leadership of its members, will be in the unique position to continue to inform the international clinical research community, physicians and patients of the likely outcomes of using anti-HIV therapy for many years.
Through merger of databases, EuroCoord will be able to make a complete inventory of individual patients under follow-up, and of clinical, laboratory and biological samples for these patients. In this manner, the system allows for a virtual common database, which can be used to test the feasibility of a potential research question and to implement new innovative research projects as they emerge. Such a process would not be possible without the overarching EuroCoord structure.
The difficulties faced in new-member states include maintaining public health campaigns to diminish further transmission, creating and establishing infrastructure, providing access to cART, and monitoring the response to treatment (as there is limited access to routine laboratory monitoring). EuroCoord will address these issues by strengthening and developing the involvement of Central and Eastern European centres to build capacity.
EuroCoord will work to improve HIV research skills throughout Europe by conducting training in statistical techniques to allow researchers to undertake observational research of the highest calibre, and to provide basic and updated laboratory and clinical training to aid the management of HIV-infected patients.
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Medical Research Council
|Official Address||Other Information|
|1||Kholoud Porter||Medical Research Council (MRC)
|2||Carlo Giaquinto||Fondazione PENTA
|3||Jens Lundgren||Københavns Universitet (UCPH)
|4||Geneviève Chêne||University of Bordeaux II (UB2)
|5||Igor Karpov||University of Minsk (BSMU)
|6||Stéphane De Wit||St. Pierre University Hospital (CHU)
|8||Juergen Rockstroh||University of Bonn (UKB)
|9||Osamah Hamouda||Robert Koch Institut (RKI)
|10||Giota Touloumi||National and Kapodistrian University of Athens (NKUA)
|11||Antonella d'Arminio Monforte||ICoNA Foundation (ICONA)
|12||Hanneke Schuitemaker||Academic Medical Centre (AMC)
|13||Frank De Wolf||Stichting HIV Monitoring (Stichting HIV Monito)
|14||Magda Rosinska||National Institute of Public Health,
National Institute of Hygiene (NIZP PZH)
|15||Silvia Asandi||Romanian Angel Appeal Foundation (RAA)
|16||Aza Rakhmanova||St. Petersburg City AIDS Centre (SPCAC)
|17||Jose Gatell||Fundació Privada Clínic per a la Recerca Bíomèdica (FCRB)
|18||Julia Del Amo||Instituto de Salud Carlos III (ISCIII)
|19||Jan Albert||Karolinska Institute (KI)
|20||Bruno Ledergerber||University of Zurich (UZH)
|21||Ruslan Malyuta||Perinatal Prevention of AIDS Initiative (PPAI)
|22||Andrew Phillips||University College London (UCL)
|23||Claus Riekehr Møller||Cadpeople A/S (Cadpeople)