The past few years have seen a considerable improvement in the prognosis of patients, but at the same time new patterns of illness among some patients and resistance to and possible toxic effects from various anti-HIV treatments are concerns that require continued monitoring. The EuroSIDA study is contributing up-to-date information on these key issues. Its primary objective is to assess the extent to which new anti-HIV therapies alter the clinical course of chronic HIV-infection in Europe.
The EuroSIDA network of clinicians (from 60 hospitals in 20 European countries including several from eastern Europe), virologists and statisticians has for the last decade examined the outcome of patients from across Europe infected with the human immunodeficiency virus (HIV), the cause of AIDS. Information from 15.000 patients has been analysed, of which 8.500 patients are included in the ongoing EuroSIDA network (initiated in 1994, funded from the Biomed 1 and 2 programmes). Switzerland currently participates with a total of 535 patients from three centres of the Swiss HIV Cohort Study (Geneva, Lausanne and Zurich).
Last year, the network produced a variety of major articles including in 'The Lancet' and in 'Annals of Internal Medicine' on the longer term clinical effects of highly active antiretroviral therapy (HAART). The network has demonstrated substantial increase in use of antiretroviral agents and because of this marked and persistent improvement in prognosis both in terms of risk of dying and risk of contracting new AIDS defining events.
Further, the network has shown that immune reconstitution (increase in blood CD4+ lymphocyte count) was clinically highly protective and thus chemoprophylaxis of opportunistic infections could safely be discontinued in this situation. This finding resulted in revisions of treatment guidelines by US public health authorities. Also, the network has shown that the pattern of disease in patients receiving HAART is changing. Relatively, more cases of malignant lymphoma are observed and more patients are dying without ever experiencing an AIDS defining disease. The latter could be explained by the occurrence of late-onset side effects from HAART (e.g. increased risk of cardiovascular disease), a hypothesis currently under intense scrutiny by the network. A central repository of plasma samples from patients followed in EuroSIDA has been established. This is an unique repository because of the associated detailed clinical and therapeutic information on the patients, and it is currently being used to address questions on the value of testing for resistance to anti-HIV drugs for predicting the clinical outcome and the spread of HIV subtypes in patients across Europe. The study will expand in the years to come; the expansion primarily used to perform more in-depth virological studies and address the issue of late-onset and rare toxicity's of HAART.
An updated list of publications can be found at:
http://www.chip.suite.dk/eurosida/publications.htm
