EuroCoord supports World
AIDS Day
Thursday 1 December marks the 23rd annual
World AIDS Day which is an opportunity to show support for people
living with HIV, to remember those who have died, and to unite in
the fight against HIV.
More than 2.2 million people are currently
living with HIV in Europe and an estimated 33 million people
worldwide have HIV. Although great improvements have been made in
treatment, many challenges remain.
How is EuroCoord helping in the fight
against HIV?
EuroCoord aims to address important issues
including the best time to start therapy and its long-term effects
in both adults and children in different populations.
This will be achieved through the unique
collaborative research structure of EuroCoord that unites over 100
research centres in 33 European countries allowing access to data
from over 270,000 HIV positive adults and children.
Funded by the
European Commission from January 2011, EuroCoord has
already made progress towards its aims by publishing over
25
research papers addressing key issues at the core of HIV
research.
When to start?
One area where data are lacking is in the
risks and benefits of starting treatment when the immune system is
still healthy. A recent analysis in EuroCoord sought to fill this
gap in knowledge, by assessing the clinical benefit of starting
treatment at high CD4 cell counts. These data are helpful to
clinicians until the results of the START clinical trial are
known.
Current guidelines in the United States
recommend patients start treatment when their CD4 count is between
350 to 500 CD4 cells/mm3 while the threshold for
treatment initiation in Europe remains at 350 CD4
cells/mm3.
The results confirmed the advantage of
treatment initiation at CD4 cell counts of 200-349
cells/mm3, with an estimate of a 25% reduction in the
risk of AIDS or death. Although the authors also found a benefit
for patients starting treatment at CD4 cell counts of 350-499
cells/mm3, this was only evident beyond 2 years.
For patients beginning treatment at higher CD4
cell counts of between 500-799 cells/mm3, the study
found that there is little clinical benefit.
Writing Committee for the CASCADE
Collaboration. Timing of HAART initiation and clinical outcomes in
human immunodeficiency virus type 1 seroconverters.Arch
Intern Med 2011;171:1560-9. [PubMed]
Drug resistance
The trend towards starting treatment at higher
CD4 counts, brings into focus potential issues around HIV drug
resistance. The EuroCoord-CHAIN project looked at the effects of
transmitted drug resistance (TDR) – resistance that has been
transmitted to an HIV positive person who has not yet started
treatment (treatment naïve). It found that patients with TDR were
more likely to fail treatment if they had received at least one
drug to which the virus had lost susceptibility.
The study also found that treatment with a
drug classified even with low-level resistance is associated with a
significantly higher risk of treatment failure, emphasising the
need for at least three fully-active drugs in the first-line
regimen and underlining the need for drug resistance testing in all
treatment-naïve patients.
Wittkop L, Günthard H, de Wolf F, Dunn D,
Cozzi-Lepri A, de Luca A, Kücherer C, Obel N, von Wyl V, Masquelier
B, Stephan C, Torti C, Antinori A, García F, Judd A, Porter K,
Thiébaut R, Castro H, van Sighem AI, Colin C, Kjaer J, Lundgren JD,
Paredes R, Pozniak A, Clotet B, Phillips A, Pillay D, Chêne G, for
the EuroCoord-CHAIN study group. Effect of transmitted drug
resistance on virological and immunological response to initial
combination antiretroviral therapy for HIV (EuroCoord-CHAIN joint
project): a European multicohort study. Lancet Infect Dis
2011;11:363-371 [PubMed]
Read the news story
Treating children
A major challenge in treating HIV positive
children is trying to minimise treatment failure and development of
drug resistance, so that treatment options continue to be available
through adolescence and adulthood.
A study published in the Lancet aimed
to assess the extent of failure and factors likely to influence
this for the three main drug classes used to treat HIV positive
children. The results showed that 12% of children with HIV in
Europe experience failure to all 3 classes by 5 years after
starting treatment and 20% by 8 years.
Although these figures are relatively low,
highlighting the great success of treatment in children, they are
higher than those experienced by adults. These findings raise
concerns about the proportion of children starting treatment who
are likely to maintain viral suppression for life, given that this
group is likely to be receiving treatment lifelong, and despite the
potential availability of newer drugs from other classes.
A separate but related study published in AIDS
looked at virological and immunological response to treatment, and
duration of initial regimens, in HIV positive infants aged under 1
year of age. Key findings were that the majority of infants
remained on their first regimens five years after starting
treatment, and that virological responses have improved over the
last decade. Possible explanations for these trends are better
dosing and efficacy of drugs, and improved adherence.
The Pursuing Later Treatment Options II
(PLATO II) project team. Risk of triple-class virologic
failure in HIV-infected children. The Lancet 2011;7:1580 -
1587 [PubMed]
European Pregnancy and Paediatric HIV
Cohort Collaboration (EPPICC). Early antiretroviral therapy in
HIV-1 infected infants in Europe, 1996-2008: treatment response and
duration of first line regimens. AIDS 2011;25:2279-2287.
[PubMed]
Read the news story
Eastern Europe
One of the main priorities of EuroCoord is to
characterise the new epidemic regions within Central & Eastern
Europe. Recent transmission levels of HIV in both adults and
children in some countries in this region have been at epidemic
rates, with Ukraine presenting the highest rate of HIV diagnoses in
Europe in 2009.
A study in the Ukraine as part of EuroCoord
compared HIV positive pregnant injecting drug users and HIV
positive pregnant women who do not inject.
It found that pregnant HIV positive injecting
drug users in Ukraine have worse clinical status, poorer access to
prevention of mother-to-child transmission prophylaxis and therapy,
more adverse pregnancy outcomes and higher risk of mother-to-child
transmission than women who are not injecting drug users. These
results are important in helping inform public health
campaigns.
Thorne C, Semenenko I, Malyuta R; for the
Ukraine European Collaborative Study Group in EuroCoord. Prevention
of mother-to-child transmission of HIV among pregnant women using
injecting drugs in Ukraine, 2000-2010. Addiction. 2011.
[Epub ahead of
print]
TB
Tuberculosis (TB) is a major cause of illness
and mortality in HIV positive patients across the world, and
although the incidence has decreased in Western Europe since the
introduction of effective therapy, levels are increasing in certain
regions of Eastern Europe.
TB is of great concern in HIV-positive
patients, especially in areas with high TB prevalence, high levels
of immigration from TB-endemic regions, and with poor access to
care.
A study by EuroCoord aimed to assess changes in the TB incidence
rate in Western Europe in the period 1994–2010, and to
compare those in Eastern and Western Europe in more recent
years (2001–2010). The authors of the study also looked at the risk
factors associated with TB in these regions.
They found that incidence rates in Western
Europe have remained at a very low and stable level since 2001.
After 2001, patients in Eastern Europe were at substantially higher
risk of TB than those in Western Europe.
Kruk A, Bannister W, Podlekareva D,
Chentsova N, Rakhmanova A, Horban A, Domingo P, Mocroft A, Lundgren
J, Kirk O; on behalf of the EuroSIDA study group. Tuberculosis
among HIV-posItive patients across Europe: changes over time and
risk factors. AIDS 2011;25:1505-13. [PubMed]
Beyond World AIDS Day
Although World AIDS Day is a good opportunity
to raise awareness of the issues surrounding HIV, the work of
EuroCoord ensures that it remains at the forefront of the European
research agenda all year round.
As well as continuing to work towards its
research aims,
EuroCoord will also build on its extensive research links to share
knowledge and expertise as part of its training
programme of work.
Read more about World AIDS
Day
See the
full list of EuroCoord publications