Casper Rokx on SHM's data in his work
Congratulation on gaining your PhD in the field of HIV! How did you come to work on HIV?
At the end of my medical training, my interests were still very broad and I ended up going to Zambia, in Africa, for a longer period of time. In this region, there are numerous issues relating to infectious diseases, internal medicine and HIV, and it was there that HIV care first triggered my interest. Eventually I returned to the Netherlands and started training as an internal medicine specialist. Soon after, I also applied to train as an infectious diseases specialist, and I’m currently in the process of completing this training. I was also very keen to do research during my training and I eventually got the opportunity to carry out research for a PhD under the supervision of Bart Rijnders and Annelies Verbon at Erasmus MC.
Could you tell us a little about your PhD research?
The main theme in my PhD thesis was the efficacy and simplification of HIV treatment: can we simplify treatment and reduce complications? This covers various aspects, such as the efficacy of first-line therapy, the safety of treatment modifications and comorbidity during treatment.
I was able to draw a number of conclusions from my research. For example, in one of the studies I was able to show that care should be taken in terms of virological failure when combining lamivudine as first-line therapy with tenofovir and efavirenz or nevirapine. This is a particularly important message for non-Western countries where there is a paucity of HIV drugs to choose from. Secondly, we carried out a number of switch studies in which patients were given a new simplified regimen and the clinical safety of these switches was assessed. Our research showed that the studied simplification strategies can be safe. Finally, we investigated the effect of HIV therapy on various comorbidities such as renal failure, cardiovascular disease and two HIV-related malignancies. One of our conclusions was that HIV treatment is a modifiable risk factor for cardiovascular disease and renal disease.
What role did SHM’s data play in your research?
SHM’s data were extremely important, even essential, to my research. Without them, I wouldn’t have been able to answer my questions. For example, SHM provides data on viral load, CD4 cell counts, etc. These are absolute numbers which are monitored; you never need to question the reliability of the data. On the other hand, the tricky thing is that SHM doesn’t register everything. For example, I needed data on thrombosis, but this isn’t something that SHM collected until we wanted to conduct a study on this subject. However, we were able to use SHM’s data to trace whether patients had used anti-thrombosis medication, and thereby find out whether individuals had had thrombosis. As this was a new project for which these data were needed, SHM could help us collect the necessary information and the collected data could also be used for monitoring.
Now that you’ve completed your PhD research, what are your plans for the future?
First I plan to complete my training as an internal medicine/infectious diseases specialist and am planning to do part of the training abroad. After that I’d like to work as an internist and infectious diseases specialist in the Netherlands and, who knows, maybe even spend some time abroad. This could be another Western country, but I’m still attracted to Africa as well. The great thing about Africa is that you can really make a difference there. Either way, I’d really like to work in a top clinic, to find out how things work there and get involved in the care for HIV patients.
Of course research will remain part of my work. I am currently involved in two branches of research: treatment and cure. In terms of treatment, we are currently investigating dolutegravir monotherapy and its efficacy. In addition, we hope to look into renal function recovery when patients stop taking tenofovir disoproxil fumarate and we plan to continue with the IRIS (immune reconstitution inflammatory syndrome) and thrombosis studies.
In terms of cure, we hope to develop interventions that limit the HIV reservoir during the phase of acute HIV infection, identify possible promising drugs to tackle the reservoir, and finally start clinical trials. The first stage of cure research obviously entails a great deal of laboratory work and we are therefore working closely together with biochemistry, immunology and virology colleagues. I think this collaboration between these various disciplines is very important in achieving an HIV cure.
Finally, I am convinced that, as we go along, new questions will arise for us to look into. After all, there’s still so much we do not understand about HIV.
So you are also looking into HIV cure. Do you think HIV will be curable in 10 years’ time?
That’s very difficult to say without having a crystal ball. At the moment, and based on what other experts in the field are saying, I don’t think we’re that far yet. That little viral RNA molecule is always one step ahead of us. I therefore think that within 10 years we may see some more Berlin patients, but I don’t think we will be able to cure people on a large scale and we won’t yet fully understand what’s required. But you never know, a breakthrough could be just around the corner!