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European and South African HIV co-infection research consortium

Final Report Summary - ESAHIVCOINFRES (European and South African HIV co-infection research consortium)

The overall aim of the ESAHIVcoinfRes staff exchange program was to establish a long lasting collaboration between South African and European research teams involved in HIV co-infection research. The consortium consisted of very complementary partners, 2 South African partners: the University of Cape Town (UCT) and University of Limpopo (UL) and 4 European partners: the Institute of Tropical Medicine (coordinating institution) and the University of Antwerp (Belgium), the Academic Medical Centre of the University of Amsterdam (The Netherlands) and the Francis Crick Institute (UK). The ultimate goal was to identify new ways to improve care and treatment for patients with HIV and HIV co-infections in order to decrease the still high mortality rate among people with HIV infection in Africa.
South Africa is the country with the largest number of HIV tuberculosis (TB) co-infected patients in the world. Therefore with this program we explored new ways to diagnose and treat TB, including multidrug resistance TB, more rapidly and studied the pathophysiological mechanisms responsible for the immune reconstitution inflammatory syndrome (IRIS).
We discovered two new dimorphic fungal infections in Southern Africa. Emmonsia africana causes disseminated infections in severely immunocompromised HIV infected and non HIV infected patients. We have found its environmental niche in soil and its distribution in small mammals. Blastomyces israeliensis presents in a number of ways including as brain abscesses.
We studied different determinants of generalized HIV epidemics and highlighted the importance of concurrent sexual relationships as an important determinant of generalized HIV epidemics. We performed several studies investigating how to optimally use antiretroviral treatment (ART).
South Africa also has a huge burden of disease caused by Hepatitis B and Human papillomavirus (HPV) infections. Therefore we carried out research concerning hepatitis B vaccine coverage and about new ways to diagnose HPV infection. At the Dikgale surveillance demographic site, Polokwane in the Limpopo province we started a project that assessed how to manage chronic diseases in a rural area and performed a study to determine cardiovascular risk factors in persons with HIV infection. In primary health care centers in the Pretoria region we evaluated an information-motivation-behavioral skills model to reduce alcohol use in patients with HIV. Of the 2230 persons with HIV infection treated at these centers 25.1% were hazardous or harmful drinkers and 2.0% had possible alcohol dependence.
During the project we trained early stage researchers in state-of-the-art field research, laboratory techniques, data collection and data analysis, have built a network of researchers interested in HIV co-infection research, formulated and performed new collaborative research projects by intensifying research partnerships and networking activities. Thanks to the project 79 papers were published and 8 researchers obtained a PhD; several others will defend their PhD in the near future.