ANNUAL REPORT 2008 TABLE OF CONTENT ISM WELCOMES CHIP 3 FROM THE DIRECTOR 5 GLOBAL COLLABORATION 8 WHO HIV INFORMATION WEBSITE 12 ORGANISATION 14 QUALITY MANAGEMENT 18 EDUCATION 20 BIOINFORMATICS 22 RANDOMISED CLINICAL TRIALS 23 INTERLEUKIN-2 STUDIES 24 ESPRIT 25 SILCAAT 26 STALWART 27 START 28 SMART 30 PASS 33 OBSERVATIONAL STUDIES 36 EUROSIDA 36 D:A:D 39 PROJECTS 43 THE CODE PROJECT 44 COHERE 46 HIV/TB PROJECT 47 EuroCOORD 48 ACTIVATE 49 NEAT 49 DISSERTATIONS IN 2008 50 FUNDING 53 ACKNOWLEDGEMENTS 55 AWARDS 55 OTHER CHIP ACTIVITES 56 PUBLICATIONS 2008 58 PRESENTATIONS 2008 61 ISIM welcomes CHIP CHIP has now for little more than a year been a member of the colourful family at the Department of Interna- tional Health, Immunology and Microbiology. CHIP has added further to the strong research profile of ISIM and we appreciate CHIP’s impressive production that contributes to fulfill the vision of ISIM “to become a centre of excellence uniquely bridging research and education in the basic sciences of immunology, viro- logy and microbiology with clinical and global health applied sciences, augmenting research outcome by collaboration”. CHIP quickly engaged in collaboration with ISIM colleagues to develop a Master in HIV education. We look forward to CHIP’s development into the field of teaching and capacity building. Welcome to ISIM. Carsten Geisler Head of Department 3 4 FROM THE DIRECTOR The dean of the University of Copenhagen and the I would like to thank all staff at CHIP for their pro- medical director of Rigshospitalet (Copenhagen Uni- fessional attitude and commitment to ensure that versity Hospital) inaugurated the new CHIP offices the focus of CHIP – to improve the handling of infec- at the Panum Institute in November 2007. The CHIP tious diseases in general and HIV in particular – has staff eagerly occupied the completely renovated offi- been and will continue to be maintained. ces - designed to match the Institute and the needs of CHIP - ready to enter a new era of the research CHIP has progressed on many fronts in the last 1-2 group’s history. Two months earlier, we had to leave years. These are described in detail in this annual Hvidovre Hospital in a hurry – after having worked report, but allow me to emphasise some of them: there for 20 years – and were temporarily housed in a vacated building close to the Panum Institute. The Clinical research has to involve the conduct of ran- 30th November 2007, when we moved in to our new domised controlled trials. offices, was indeed a lovely day, and we are conti- CHIP has been heavily involved in further analysis nuously grateful to the University and to Rigshospi- of the data from the SMART trial, where follow-up talet for allowing this to happen. was completed in 2007. Three years ago the SMART results were unblinded and we expect that the num- Despite the “logistical turmoil” experienced by CHIP, ber of articles will at least be doubled in the next 1-2 the group was not thrown into “research turmoil”. years from the current tally of 30 articles. As a matter of fact, the research has never been as The ESPRIT Study was initiated in 1999, and follow- productive as it has been in the last couple of years. up was completed on 15th November 2008. The un- It continues to amaze me how critical key people, blinding of the results will occur in Buenos Aires in and how these people interact, are to whether early January 2009 – 10 years to answer a research research becomes productive or not. CHIP has been question and 2 minutes to hear the answer, but fortunate to attract unique persons with a drive that what a treat: “Those two minutes encapsulate what makes things happen and sees things through. research is all about”. Of note, it is my strong belief that the temporal The PASS study has been another impressive achie- relationship between logistical turmoil and impro- vement – more than 950 patients have been rando- vement in research productivity has not been causal mised from 8 intensive care units across Denmark – rather, the fact that research productivity did not – an unprecedented academic collaboration; we will deteriorate merely shows the steadfast determinati- see the results of the PASS study in 2009. on to ensure that circumstances outside our control should not influence the purpose for why we work In 2009, the “Strategic Timing of Antiretroviral Treat- in the first place. A high price to pay, you may say- ment (START)” study will be initiated; the first (and and certainly in 2008, the cost has come in various likely the only) randomised clinical trial that will shapes and sizes. place the critical, strategic question: “When to start antiretroviral therapy?”. This question has been 5 debated and has caused controversy ever since the We have initiated this already, and will continue to first antiretroviral drugs became available in the end do so in the years to come. CHIP fully supports the of the 1980s – and now we have the chance to do vision of creating a “Copenhagen School of Global a randomised clinical trial to answer this question Health” together with our colleagues at the de- properly. An additional bonus is that the rationale partment of International Health, Immunology and for START derives from research-findings that CHIP Microbiology (ISIM). This school will create a com- either contributed to or led. prehensive educational platform for graduates from around the world. Only by continually expanding on The European HIV trials network (NEAT) will hopeful- this vision can we truly rely on low-resourced parts ly also in 2009 get its first trials underway. of the world being fully capable of developing their health infrastructure. The CHIP contribution to the The D:A:D study aroused the most excitement in vision is expertise in viral diseases and clinical re- 2008. Much to our surprise a new set of analysis of search methodology related to infectious diseases. this large collaborative project - initiated in 1999 - CHIP is e.g. working on the initiation of a “Master in demonstrated that the antiretroviral drug abacavir HIV”. Hopefully, resources will become available to was associated with an excess risk of cardiovascular support the vision. disease. We (and many others) did not believe this, but subsequent studies supported the finding, and Our collaboration with the WHO continued in 2008. various treatment guidelines have consequentially CHIP has participated in various meetings at WHO used this observation to change their advice. The headquarters and at regional levels. A publication abacavir story encapsulates what CHIP wants to in the Lancet on how to best monitor the effects of achieve. antiretroviral therapy in a poorly resourced environ- ment started considerable discussion. In 2008 the EuroSIDA continues to produce a steady number of Gates Foundation and the European Commission publications. EuroSIDA extended its collaboration decided to fund a WHO-led development of phar- to involve hospitals in the Eastern region of Europe macovigilance research infrastructure in resource some 10 years ago and this has been a major asset. limited settings. CHIP will continue to support and Good and trusted collaborative relationships have contribute to these activities. Through the D:A:D been established and now facilitate new projects, study, CHIP is involved in similar projects with the e.g. the study of the negative interaction between European Medicines Evaluation Agency (EMEA). HIV and tuberculosis. In 2009 EuroSIDA will enter as one of 5 partners in a joint application to the Recently, CHIP has focused on a major question - European Commission under the working name how to reduce the number of persons infected but “EuroCOORD”. not yet diagnosed with HIV. In Europe (including Eastern Europe), half of the HIV-infected persons As CHIP is now part of the University of Copenha- fall into this category. The University of Copenhagen gen we are required to reach out to the educational co-chaired a meeting on early diagnosis and care component of the activities within the institution. for HIV-infected persons across Europe in November 6 2007. CHIP has subsequently followed up on this CHIP is related to Rigshospitalet in other ways, initiative in collaboration with European patient-ad- more specifically to the department of clinical vocacy groups and policy makers. A major achieve- microbiology (centre for viral diseases (CVD)) and to ment was the adoption by the European Parliament the department of infectious diseases. Attempts to of a resolution on the exact action points we had establish fruitful research collaborations to better identified. The adoption of the resolution took place understand viral disease management post-trans- on the 19th November 2008 by the vote of 480 for plantation have been the main focus. and 4 against (!). The main focus is now to hold the politicians accountable for the resolution´s trans- The future of CHIP is going to be interesting to formation into action. To assist and support this follow. In research, and in particular in research process, a European steering committee, co-chaired funded 100% from international sources, the future by CHIP, has been formed. The new projects include entirely depends on being able to continue to raise the creation of further evidence for how best to use new funds for new projects. This is done in direct the concept of “indicator-disease” guided testing competition with other international institutions. for HIV; better understanding of the adverse con- CHIP has benefited from this competition in the sequences of the expanded legislation across the last decade; it has allowed us to focus on the best continent that criminalises behaviour once a person research and our research productivity reflects that.