Interview of Professor Jürgen Rockstroh

Good progress made but still room for improvement – AIDS specialist assesses current trends

Joining ISHEID in 2012 for the ninth time, Dr Rockstroh explained to us recently why he keeps coming back to Marseille for the biennial HIV and emerging infectious diseases conference.

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He explained that he particularly valued the interactive aspects of the ISHEID event. "Sometimes with very large conferences you lose the possibility for a real exchange," he said. "At ISHEID you have enough people to make it stimulating but you can still have a great interaction. These are people who are really treating patients. It is more clinically oriented, so it is very useful for hearing about protocols, new studies and exchanging ideas."

For the 2012 event, Dr Rockstroh is a member of the scientific committee, helping shape the programme. He elaborated on some of the current issues he was looking forward to hearing addressed at ISHEID. "In the first instance, there is always a debate about the most recent guidelines," he said. "Differences exist between American guidelines and those from other countries. How early should we start therapy? This is of general concern."

Further, Dr Rockstroh explained that there had been a fundamental change in the management of patients co-infected with Hepatitis C. "As new drugs have become available, we can expect much higher cure rates," he said. "France is one of the first countries to begin treating with recently approved drug compounds and we need to see the results of those first experiences."

The last 10 years have seen major advances in the fight against AIDS and some disappointments, too. "One a more optimistic note, HIV has become a treatable disease and the majority of patients can be suppressed," Dr Rockstroh said. "But we still have no cure and there is considerable toxicity with the drugs we are giving. Also, vaccination is not yet attached to the success rates that we need."

While treatments for HIV patients have improved dramatically over recent years, Dr Rockstroh has noted a slight increase in new infections since 2006. "We are seeing a clustering increasingly in patients who are coming from a group that is poor," he said. "We see more social problems in the patients. Patients are also changing as they come to terms with the fact that they have lost loved ones around them. We have a lot of age-related issues where people are depressed and sometimes very lonely."

Universal access to treatment remains a sore point, too, being limited and linked to economic wealth. "A multi-disciplinary effort will be required to provide treatment for all sufferers," he said. "It is not just to get everyone on treatment but also to tackle the problems of continuing supply. In Eastern Europe we have seen that the stock of drugs is low, so we need to work better to maintain a constant supply. Politicians and physicians need to join together to fight with the same goal, and clearly with the economic crisis this has become increasingly difficult."

One way Dr Rockstroh has found to work constructively in areas with differing levels of access to treatment is to go directly into the communities and participate in knowledge exchange with medical practitioners and patients on the ground. In March this year, he visited Pune, India, as one of the leaders of an intensive course in HIV medicine. "I was invited by Sanjay Pujari to help them with the formulation of guidelines, discuss clinical cases and pass on knowledge," he said.

"I find that actually going somewhere and seeing their situation is very helpful to understand their needs, rather than everyone coming to visit my unit. Some of the things may not relate to what they are seeing and how the Indian system works so it is not always relevant. For example, their use of resistance testing is much lower because of lower reimbursements. Everyone receives the treatment without being tested beforehand."

"On the other hand, their tuberculosis treatment experience is much better than ours because they see so many more cases. It was certainly a mutual learning and teaching experience for me."

To find out more about the search for a cure join us at ISHEID, 23-35 May 2012.

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