Frank de Wolf is Associate Professor in Virology at the Academic Medical Centre of the University of Amsterdam
Human immunodeficiency virus infections
My main research interest is in human immunodeficiency virus infections. Current research focuses on the changes in the course of HIV infection following the introduction of antiretroviral treatment. A large observational clinical cohort of HIV infected individuals on HAART is set up and clinical, epidemiological, socio-demographic, as well as virological, immunological and pharmacological data are analysed with respect to the effect of treatment on HIV replication and the immune status of patients. In addition changes in HIV-related morbidity and mortality patterns are studied. Adherence to the drugs is measured and related to the effect of antiretroviral therapy. Toxicity and development of resistance of HIV to antiretroviral drugs are studied in conjunction with the results from the adherence studies. Finally, using data from this observational cohort and from hospital administrations, cost benefit studies are done, as well. Methods used, are plain descriptive analyses of data and, especially for the comparisons of the effects of different HAART regimens and the prediction of disease outcome under therapy, statistical models. Data obtained are used to fit mathematical models of the pathogenesis of HIV, including the primary infection. Recent results reported to the Dutch Health Insurance Council and the Dutch Ministry of Health show a dramatic decline of the amount of virus circulating in the infected population after the introduction of HAART and an impressive increase in the immune status in both optimally and sub-optimally treated HIV-infected patients. Morbidity and mortality as measured over a period of four years after the introduction of HAART in 1996 show a decline, as well. Quality of life of the HIV-infected population improved after start of HAART, although not to levels of the general non-infected population. The infected population appeared to be less adherent to the drugs prescribed when, apart from to the number of pills, time and dietary requirements were taken into account. Resistance of HIV to the drugs used in HAART combinations is still a limited problem, although resistance levels were high at therapy failure and pre-existent resistance was found.
For the near future research questions to be answered are:
- What are the differences in virological and clinical effect of various HAART regimens
- What are the effects of treatment interruptions and can effects be predicted based on pathogenesis models of the infection
- What are long term trends in virus replication and immune status under HAART
- How does resistance patterns change under prolonged HAART treatment and what are the effects on therapy outcome in terms of prevention of disease and death
- Are there any differences in treatment effects between different risk groups for HIV and AIDS
- New emerging diagnoses in treated HIV, relationship with toxicity of the drugs used.
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