1 May 2011
Interview:
“HIV prevention and monitoring is still an urgent matter”
 |
A short interview with Prof. Frank de Wolf, director of SHM (the Dutch HIV monitoring foundation) |
First of all, congratulations on the 10th anniversary of SHM and the launch of its new house style and website.
Frank de Wolf: "Thanks. The new website was really necessary; it is more in line with the actual activities of SHM. A big step forward. We try to involve patients, physicians and researchers more in developments in the field of HIV in The Netherlands. Each year there are more than 1100 people with new HIV infections and the number of diagnoses among men who have sex with men (MSM) is growing. "
How do you account for this increase?
Frank de Wolf: "The number of diagnoses is growing because more people are being tested for HIV. What we learn from monitoring HIV is that there are a growing number of people with a positive test where the last negative test is known. The willingness to test among those at risk is increasing. However, this means that we are talking about recent infections. And the increase also means that more risks are being taken. Ongoing attention towards prevention is needed to control the continuous growth of this epidemic.”
What could possibly be done to turn this situation around?
Frank de Wolf: "Tailor-made prevention campaigns focusing on condom use, changing risk behaviours and HIV testing aimed at men who have homosexual contact. Remember that there are an estimated 8,000 to 10,000 people in our country who do not know they are infected with HIV. This underlines the importance of good HIV prevention. A good testing policy also helps people with HIV to get started early on HIV treatment. That is important to get the best effect. As of June 2010, the Netherlands had 13,035 HIV-infected patients, including 12,946 adults and 89 children and adolescents under treatment at one of the 25 HIV treatment centres in the Netherlands. "
There must have been successes as well?
Frank de Wolf: "Yes. Since the introduction of cART (combined antiretroviral therapy), incidence of AIDS and mortality rates amongst HIV infected individuals have declined. HIV therapy increases the number of white blood cells (CD4 cells) in the body, which means that HIV-infected persons receiving cART have an increased resistance to infections and other diseases.”
"And the increase in testing for HIV is also an important success. Such as, for example, testing all pregnant women for HIV to help prevent transmission of HIV to the child. It’s then possible to start the mother on treatment during the pregnancy. The number of children born with HIV in the Netherlands is expected to stay close to zero as a result of the ongoing screening of HIV among pregnant women.”
Are there any particular challenges worth mentioning here?
Frank de Wolf: "Research on testing behaviour and HIV transmission risk behaviour remains important. The GGD in Amsterdam and the Schorer institute are doing a lot of work in this area. Through our research at SHM, we want to understand how HIV adapts itself to the host and the factors that determine particular host responses to HIV. Furthermore, it appears that chronic infection with HIV and the lifelong treatment of HIV leads to other complications: more cardiovascular disease, but also severe liver and kidney disease. Our monitoring is necessary to clarify these matters. "
There’s plenty of work to be done in the next years, I guess.
Frank de Wolf: "Yes. There’s still no vaccine that adequately protects against HIV and that could help to bring the HIV epidemic under control. As a result, there will always be people that become infected with HIV and the number of people living with HIV and treated with HIV therapies will continue to grow, also in the Western world. These therapies do not cure and will probably lead to an increase in non-HIV related diseases among HIV-positive people. We will continue to monitor that, give this information to physicians and researchers, and thereby contribute to the understanding and knowledge of the epidemic and treatment of HIV, as well as the quality of HIV care in the Netherlands.”
There must have been successes as well?
Frank deWolf: "Yes. Since the introduction of cART (combined antiretroviral therapy), incidence of AIDS and mortality rates amongst HIV infected individuals have declined. HIV therapy increases the number of white blood cells (CD4 cells) in the body, which means that HIV-infected persons receiving cART have an increased resistance to infections and other diseases.”
"And the increase in testing for HIV is also an important success. Such as, for example, testing all pregnant women for HIV to help prevent transmission of HIV to the child. It’s then possible to start the mother on treatment during the pregnancy. The number of children born with HIV in the Netherlands is expected to stay close to zero as a result of the ongoing screening of HIV among pregnant women.”
Are there any particular challenges worth mentioning here?
Frank de Wolf: "Research on testing behaviour and HIV transmission risk behaviour remains important. The GGD in Amsterdam and the Schorer institute are doing a lot of work in this area. Through our research at SHM, we want to understand how HIV adapts itself to the host and the factors that determine particular host responses to HIV. Furthermore, it appears that chronic infection with HIV and the lifelong treatment of HIV leads to other complications: more cardiovascular disease, but also severe liver and kidney disease. Our monitoring is necessary to clarify these matters. "
There’s plenty of work to be done in the next years, I guess.
Frank de Wolf: "Yes. There’s still no vaccine that adequately protects against HIV and that could help to bring the HIV epidemic under control. As a result, there will always be people that become infected with HIV and the number of people living with HIV and treated with HIV therapies will continue to grow, also in the Western world. These therapies do not cure and will probably lead to an increase in non-HIV related diseases among HIV-positive people. We will continue to monitor that, give this information to physicians and researchers, and thereby contribute to the understanding and knowledge of the epidemic and treatment of HIV, as well as the quality of HIV care in the Netherlands.”
