Colette Smit

Epidemiologist
I’m working as an epidemiologist at the Stichting HIV Monitoring. The main focus of my research is developing statistical models to understand the role of hepatitis B and C co-infection in the HIV disease progression and the impact of treatment of co-infections in this progression. I also work on mathematical models that measure the quality of HIV care in the Dutch HIV treatment centres. This work has been done in collaboration with the Department of infectious disease Epidemiology of Imperial College London.

HIV co-infections

Hepatitis B&C
As a result of shared routes of transmission, hepatitis B (HBV) and hepatitis C (HCV) are highly prevalent amongst HIV-infected individuals. HBV is a common infection amongst injecting drug users and homosexual men. HCV is mostly transmitted by injecting drug use or through blood or blood contact. Since 2000, HCV infections amongst HIV-infected MSM who did not report injecting drug use have been observed in Western countries. These infections were not likely to be caused by blood contact, suggesting that among MSM HCV acquisition is predominantly through sexual contact. Irrespective of co-infection with HIV, HBV and HCV infections are associated with liver fibrosis, cirrhosis and hepatocellular carcinoma. However, HIV infection alters the natural history of HBV and HCV and progression of HBV and HCV-related liver disease is accelerated by the presence of HIV. The impact of HBV and HCV on the progression of HIV is still unclear.

Sexually transmitted infections
Sexually transmitted infections (STI’s) are relatively frequent amongst HIV-infected individuals and especially amongst young adults and homosexual men. STI’s are considered as a marker for sexual risk behaviour in specific populations. Therefore, by monitoring trends in the occurrence of STI’s amongst HIV-infected individuals we may improve our understanding of changes in risk behaviour over time. 

Quality of HIV care
In the study of quality of care, much attention is given to internal processes, sometimes including a comparison of the different centres to a national average. However this comparison of different centres is not straightforward, because the indicators of good patient management and successful initiation of combination anti retroviral treatment can be influenced by the profile of the patients and by the attributes of the centre itself. We have been working on a mathematical model that explains differences between different treatment centres and we are looking for indicators to determine quality of HIV care.

Selected publications

 
 

© Stichting HIV Monitoring | Disclaimer | Colofon

Stichting HIV Monitoring

De Stichting HIV Monitoring (SHM) levert een belangrijke en nood­zakelijke bijdrage aan de zorg voor mensen met HIV in Nederland.

Door middel van het verzamelen en bewerken van anonieme data van HIV-patiënten uit het hele land draagt ons monitor-onderzoek structureel bij aan de kennis van HIV en stelt het behandelend artsen in staat om de zorg voor hun patiënten continu te verbeteren.

Ons jaarlijkse monitoringrapport geeft waardevolle input voor het ontwikkelen van HIV-zorg- en preventiebeleid in Nederland en binnen de Europese Unie.