| Since the emergence of HIV-AIDS in the early eighties, HIV research at the University of Amsterdam/AMC is conducted by a number of closely collaborating centers which are all part of ACII. The Amsterdam Cohort studies on AIDS are a multidisciplinary collaboration between the Amsterdam Municipal Health Service for the epidemiology of HIV infection and data management, the department of Human Retrovirology for serum storage and studies on virological aspects, the ITA for related clinical research on HIV infected patients and Sanquin Research for blood cell storage and for immunology and pathogenesis studies. Within this framework two cohorts have been followed: homosexual men since 1984 and (injecting) drug users since 1985. Over the years about 4000 persons have been included of whom data are available on risk behavior, demographic background, morbidity, mortality and immunological and virological tests; from each visit serum and often also (viable) cell samples have been stored and are available for retrospective laboratory studies. An important research topic at the Municipal Health Service is the recent increase of risk behavior, sexually transmitted diseases and HIV among homosexual men. This rise in Amsterdam was thoroughly documented and the possible reasons have been identified, in part by comparing the Amsterdam data with other cities experiencing a similar increase. Surveillance of HIV and risk behavior in Amsterdam among other groups remains an important task, e.g. among pregnant women, drug users and heterosexuals. The Municipal Health Service also monitors and tries to predict the future development of resistance to anti-retroviral drugs in the city in collaboration with the HIV monitoring foundation. In another project the Municipal Health Service aims to elucidate the links between HIV viruses circulating in Surinam/the Dutch Antilles and the Netherlands, both by sequencing studies of HIV isolates and by social scientific data collection. Several departments participating in ACII are involved in the care of patients with tuberculosis. The Municipal Health Service occupies a central role in the screening for and the treatment of tuberculosis in Amsterdam; approximately 200 patients are treated for tuberculosis here annually. The Municipal Heath Service investigates the molecular epidemiology of tuberculosis in Amsterdam and North Holland in a collaborative project with the National Institute of Public Health. In the AMC patients with tuberculosis are treated by physicians working in ITA or the Department of Pulmonology. Hepatitis is studied in a collaborative effort of the Department of Clinical Virology, the Department of Hepatology and the Municipal Health Service. Treatment of hepatitis B and hepatitis C necessitates the application of advanced diagnostic procedures, such as genotyping of HBV and HCV; sensitive qualitative and reproducible quantitative detection of HBV-DNA and HCV-RNA; and the detection of viral mutations causing resistance to antiviral agents. In this field, the Department of Clinical Virology, closely co-operating with clinical hepatologists within the AMC and with leading commercial partners, continuously evaluates and develops next generations assays. The Department of Hepatology/AMC Liver Center controls a large group of patients with chronic hepatitis C and B. Clinical trials are organized to advance the treatment of viral hepatitis. The main emphasis is on small innovative trials on therapeutic vaccination, protease and RNA/DNA polymerase inhibitors and new delivery formulations of a-interferon. Clinical and fundamental research is performed in collaboration the Departments of Clinical Virology and Experimental Immunology and numerous small business partners as well as large pharmaceutical companies. Public Health aspects of the treatment of viral hepatitis in a large cohort of patients are studied in collaboration with the Municipal Health Service. The Municipal Health Service studies the epidemiology of hepatitis C. HCV infection is highly prevalent among the Amsterdam injecting drug users cohort. In this group the natural history of HCV infection is studied, both clinically and immunologically. The molecular epidemiology of hepatitis C is another topic: HCV isolates from different sources are typed, e.g. from blood donors, migrants etc., to obtain a better picture of the spread of HCV in Amsterdam and elsewhere. In a collaborative effort of the Municipal Health Service and the Department of Hepatology in the AMC treatment initiatives are initiated. The molecular epidemiology of hepatitis B is monitored nationwide by the Municipal Health Service together with the national Institute of Public Health to obtain insight in the changing trend under the influence of intervention measures (vaccination). Furthermore, molecular typing is used to study the spread of hepatitis A in Amsterdam and several other areas of the country; in addition the natural history of this disease is determined, concentrating on the virology. |
