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Foreword
Jürgen Rockstroh
Professor of Medicine, and Head, HIV Outpatient Clinic, University of Bonn
Jürgen Rockstroh is a Professor of Medicine and Head of the HIV Outpatient Clinic at the University of Bonn, where his department treats the
world’s largest cohort of HIV-infected haemophiliacs. In addition to his clinical practice, Professor Rockstroh is involved in HIV research, focusing
on antiretroviral therapy, including new drug classes, the course of HIV disease in haemophiliacs and all aspects around HIV and hepatitis B and
C co-infection. He has served as a study investigator in multiple clinical trials of antiretrovirals and of treatments for HIV and hepatitis C virus
co-infection. Professor Rockstroh has authored, co-authored or collobarated on over 200 publications in peer-reviewed journals, as well as over
30 book chapters. An active member of the HIV/AIDS treatment community, Dr Rockstroh has served as Chairman of the German Clinical AIDS
Working Group (KAAD) from 1998 to 2007. In June 2007, he was elected as the new Chair of the German AIDS Society. In 2002, the German
Society for Infectious Diseases awarded Dr Rockstroh and his co-authors the prize in clinical infectious diseases for their study of the HIV-
protective CC chemokine receptor 5-Delta32/Delta32 genotype in hepatitis C antibody-positive patients. The same society awarded him and his
co-authors the AIDS prize in 2005. Professor Rockstroh is Co-Chair of the upcoming European AIDS Conference in Cologne in 2009.
O
ver two decades have passed since the introduction of the first antiretroviral agent in 1987, and since then the
treatment of HIV has been revolutionised. Starting with monotherapy, which is characterised by only temporary
virological efficacy and clinical improvement due to subsequent development of resistance, the concept of antiretroviral
combination therapy has evolved. This has allowed long-term control of HIV replication without emergence of resistance,
which has led to a dramatic reduction in HIV-associated morbidity and mortality. Hardly any other disease area can offer such
a success story in terms of treatment development in such a short time. Nevertheless, the challenges remaining are
tremendous. Most importantly, in order to fulfil the pledge to supply all HIV patients with therapy, access to life-saving
medication needs to be underlined. However, even in the industrialised Western world – where access to antiretrovirals is
usually guaranteed by national healthcare systems – one-third of patients start HIV therapy late (when the CD4 cell-count has
fallen below 200 copies/µl), indicating that there is a need to improve testing procedures in European countries. Success rates
of HIV therapy at this late stage tend to be compromised compared with earlier treatment initiation. In Eastern Europe, as
many as 70% of patients do not know their diagnosis, reinforcing the need for improved access to testing as well as access
to treatment in these areas.
For those on HIV therapy, management challenges remain with regard to long-term tolerability, particularly issues around
lipodystrophy, increased cardiovascular risk (which has been associated with various antiretroviral agents), recent reports of
features of portal hypertension (even if the patient has not developed cirrhosis or does not have underlying chronic hepatitis
or an alcohol abuse problem) and increased bone fractures, suggesting that osteopenia and osteoporosis within the aging
population will eventually lead to a clinically relevant problem. Moreover, HIV itself constantly challenges the immune system
by inducing immune activation. Indeed, increasing evidence is arising suggesting that HIV-induced immune activation not
only leads to an increase in inflammation markers but also may cause increases in vascular sclerosis, contributing to vascular
disease and promoting liver fibrosis progression in patients with HIV and chronic hepatitis co-infection. Finally, increased
rates of anal and cervical cancer, as well as alarming signals of rising cancer rates of other origin, clearly need to be further
addressed and evaluated.
The rapid changes in HIV medicine and the remaining clinical challenges underline the necessity of bringing together
colleagues active in the HIV field and physicians taking care of patients. The opportunity of exchange will help to ensure
quality care and to transport new findings into clinical practice. From 11 to 14 November 2009, the European AIDS
Conference conducted by the European AIDS Clinical Society will take place in Cologne. This upcoming highlight for 2009
will allow physicians from all over the world to come together and discuss impending challenges and issues in HIV medicine.
I would be extremely happy to welcome you there and hope for a fruitful and inspiring exchange. ■
12 © TOUCH BRIEFINGS 2008
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