In just over a year the EuroCoord project has brought together all the leading players in HIV research to create a huge study based on 250 000 individuals with the disease. As work gathers pace, the researchers involved are plugging the gaps in understanding how HIV emerges and evolves, striving towards smarter drug treatments that focus more on the individual.
At the end of a five-year project the big goal beckons of completing a computer simulation that predicts numbers of people at all stages of HIV, both diagnosed and yet to be diagnosed, and whether or not they are in need of treatment, for any given country. There really is no comparison with the impact in the past of research programmes in institutes that couldn’t easily link up and struggled to look beyond their own countries. HIV cuts across racial and cultural barriers, with the potential of devastating lives. There are great benefits in being able to study the disease and its treatments across continents and EuroCoord has access to a unique range of cohorts.
For instance, the CASCADE dataset contains data from 26 000 individuals with known or close indications of HIV infection dates.
The majority (22) are European, but 3 cohorts are Australian, 1 Canadian and 2 are from sub-Saharan Africa. Immediately the EuroCoord data take on a new relevance, offering insights into when treatments can best be started and the impact they have already made on the lives of people affected.
Since EuroCoord is a network of institutions, all partners retain ownership of their own data whilst using everything that is available from others. This is proving to be invaluable in assessments of African data, but is also shedding new light on the progression of the disease in Central and Eastern Europe.
In the initial stages of the project a particularly exciting development has been new understanding about the optimum time to start treatment, based on more precise data regarding a person’s immune system. The latest information through EuroCoord sheds light on the benefits and risks of starting anti-retroviral drug treatments when the patient still has a strong immune system.
Results now show how there is limited, if any, benefit of treating patients with higher (350- 500) CD4 cell counts, the cells which organise the immune system’s response to bacteria, fungi and viruses. This is just one aspect of optimising treatment programmes and tailoring them increasingly to the needs of the individual patient.
Even experienced institutions face research issues that they can’t overcome alone, but EuroCoord’s involvement with over 100 research centres aims to overcome this hurdle. The team focusing on training is committed to raising performance across the board, with online training resources and residential courses that improve research skills and laboratory and clinical training. Every part of the project receives training support by rotating staff.
HIV+ women are also closely monitored within the EuroCoord cohorts. Specific approaches to treatment and the timing of drugs is particularly important in this field, as investigators gain greater insight into HIV transmission during pregnancy and how the health of the mother and child can be better managed.
Researchers are excited at how quickly data are being collected to form the basis of an ambitious computer simulation of all aspects of the disease. It is continually gathering momentum and mapping the number of diagnosed and likely undiagnosed cases. From there it will look deeper at the most vulnerable cases with CD4 cell counts of <200 or <350. It will estimate not only total numbers in need of anti-retroviral drugs, but equally important how many are likely to develop drug resistance.
No other collaborative work in this field can match the volume and quality of data that EuroCoord receives and it is therefore no surprise that the model that is emerging gives a unique insight into HIV in our generation.
Project acronym: EuroCoord
Participants: United Kingdom (Coordinator), France, Denmark, Sweden, Ukraine, Poland, Spain, Romania, Germany, Greece, Italy, Netherlands, Switzerland