Blog posts

World AIDS Day: Dr Katharina Hauck on the health economics of fighting HIV

Katharina Hauck speaking at the Annual Meeting 2017 of the World Economic Forum in Davos (Copyright by World Economic Forum / Sikarin Thanachaiary)

World AIDS Day takes place annually on 1 December as an opportunity for people worldwide to unite in the fight against HIV and to show support for people living with HIV/AIDS.

To mark World AIDS Day 2017, we have published a series of blog posts to highlight the important and varied research that takes places at Imperial. Three experts from Faculty of Medicine share their interest in HIV/AIDS which spans from the elusive vaccine to the economics of the epidemic.


The role of an economist in the HIV epidemic

As an economist, my research on HIV takes a higher-level population view. We advise policy makers in governments and international organisations on the cost-effectiveness of preventive and treatment interventions in the countries most ravaged by HIV. By estimating the benefits and costs of interventions, we can identify the ones that promise greatest improvements in population health.

The largest community-randomised trial of the universal HIV test and treat strategy

For example, we are currently conducting an economic evaluation of HPTN071/PopART; the largest study on the impact of a package of testing and prevention interventions on new infections in Zambia and South Africa. We measure the benefits of treatment to HIV-infected individuals who are found and diagnosed earlier because of PopART, and we expect that the interventions will also prevent new infections. It’s tricky to estimate exactly how many individuals will be spared from getting infected in future, but we work with epidemiologists who use complex modelling to project the number of prevented infections into the future. (more…)

World AIDS Day: Professor Mark Bower on HIV-related cancers

World AIDS Day takes place annually on 1 December as an opportunity for people worldwide to unite in the fight against HIV and to show support for people living with HIV/AIDS.

To mark World AIDS Day 2017, we have published a series of blog posts to highlight the important and varied research that takes places at Imperial. Three experts from Faculty of Medicine share their interest in HIV/AIDS which spans from the elusive vaccine to the economics of the epidemic.


Oncologist turned HIV expert

As a medical oncologist at Chelsea and Westminster Hospital, I specialise in the treatment of HIV-related cancers at the National Centre for HIV Malignancy – Europe’s largest research and treatment institute for these cancers. Over the last 25 years, I have seen an astonishing improvement in the outcomes of people diagnosed with both HIV and cancer, so that patients under my care with most HIV associated cancers now have the same overall survival as HIV negative patients.

The population of people living with HIV is ageing

One less welcome finding in recent years is the rising number of non-AIDS defining cancers – cancers not previously associated with severe immunosuppression and AIDS – amongst people living with HIV. Overall, the risk of cancer rises with age, although the age-related risk of individual types of cancers varies. In the UK half of all cancers are diagnosed in people over the age of 70 years old. The combination of increasing age of people living with HIV and the rising rates of cancer with age, is reflected in the changing epidemiology of non-AIDS defining cancers amongst people living with HIV. This was first described in the US by Shiels in 2011 who reported a three-fold rise in the rates of non-AIDS defining cancers between 1991 and 2005, and by 2005, 60% of these cancers occurred in people over 50 years old. We have since described the same phenomenon at the National Centre for HIV Malignancy, Chelsea and Westminster Hospital and in a pan-European cohort. (more…)

How a little Mo effort can make a big difference

It’s that time of the year again, when men grow moustaches around the globe. It all started in 2003, when two guys in Australia had the idea to make moustache-growing fashionable again. For a greater cause, they made this campaign about men’s health and established the Movember Foundation. As you may know, the campaign became an international phenomenon, attracting over 300,000 participants in more than 20 countries in 2016.

The Movember Foundation is now a global charity with one mission: “Stop men dying too young”. To achieve this, they are raising awareness and funds for three issues affecting men’s health; prostate cancer, testicular cancer and mental health. Here in the UK, the Movember Foundation has been working together with Prostate Cancer UK – the only charity that exists solely for prostate cancer – investing over £21 million in prostate cancer research between 2012 and 2015.

The prostate is a male-specific organ that sits just beneath the bladder and surrounds the urethra – this location is the reason so many symptoms of prostate disease affect the ability to urinate. Prostate cancer occurs when cells in the prostate grow and divide out of control. In the UK, prostate cancer is the most common cancer amongst men and expected to affect 1 in 8 men during their lifetime. The word ‘cancer’ sounds frightening, but it needn’t be for all cases of prostate cancer. When diagnosed at the earliest stage, virtually all men survive beyond 5 years. However, when diagnosed at the latest stage (advanced prostate cancer) only 30% of men survive beyond 5 years, indicating early detection is key. (more…)

“Don’t you just get the summer off?”

“Don’t you just get the summer off?” – James Moss
Not quite a million-dollar question, but one I am often asked by students I bump into over the summer months, who seem perplexed to see me on College premises. “But there’s no teaching” they’ll say, which is a fair and accurate statement. My job title is Teaching Fellow, which means I’m employed to design and deliver teaching sessions for our students. Fortunately for me, variety is the spice of life, and there are lots of different ways I spend my time.

Exam marking

This summer I marked way over ten thousand marks worth of questions across five different exams, which is almost 37.5 hours in itself (technically a full week of work!), and these papers get turned around – marked, double-marked and ratified – within ten days in time for the exam board (a meeting with senior teaching staff and external examiners).

Research

This summer I’m working on different research projects, along with all of the other things. Several of these are collaborations with undergraduate students on medical education projects (like evaluating new teaching methods or software to support learning), which is an exciting way to work and provides students with a unique experience (and hopefully a taste of research that can inspire them in the future). (more…)

Give HIV the Finger – National HIV Testing Week 2017

HIV testing week

It is the time of year again for HIV Testing Week!

Coordinated by HIV Prevention England (HPE) since 2012, National HIV Testing week has focused on three main aims:

  • improving awareness of HIV testing, particularly among communities at high-risk
  • increasing opportunities to take the test in clinics and other community settings
  • reducing the number of people diagnosed with HIV at a late stage

This year’s theme is ‘Give HIV the Finger’ – a cheeky reference to the free finger-prick test that people can receive by post, to provide a blood sample for testing without attending a clinic.

HIV in the United Kingdom

According the latest surveillance from Public Health England (PHE), just over 5,000 people were diagnosed with HIV in 2016; this is an 18% drop compared with 2015.[i] 54% of diagnoses were among gay and bisexual men; 19% and 22% among heterosexual men and women respectively. Late diagnosis is an important predictor of morbidity and premature death in people with HIV. In 2016, 42% diagnoses were made at a late stage of infection when treatment is less effective. (more…)

Lung volume reduction – new hopes and missed opportunities in COPD


COPD, chronic obstructive pulmonary disease, has traditionally been thought of as an irreversible and somewhat hopeless condition. Many patients with COPD may be missing out on the possibility for a dramatic improvement in their condition. They deserve better.

COPD, is a common and important condition. There are 1.3 million people with a diagnosis of COPD in the UK and it’s now the third leading cause of death worldwide. The main symptoms are breathlessness, cough and sputum production.

The term COPD encompasses a range of pathological processes, usually caused by smoking or inhaling other noxious materials. It includes chronic bronchitis – inflammation and damage to airways as well as emphysema – destruction of the lung tissue itself and damage to the blood vessels in the lung. In emphysema the walls of the alveoli (air sacs) break down. The lung tissue loses its elasticity and becomes baggy, and air gets trapped in the lungs making breathing uncomfortable. In some people the condition is caused by alpha one antitrypsin (A1AT) deficiency; the inherited lack of a defensive enzyme, which makes their lungs much more vulnerable.

There are treatments including inhaled medication, pulmonary rehabilitation and flu vaccination, and for people who continue to smoke, smoking cessation is the most effective. Despite the best standard care the condition is progressive and conventional treatments cannot so far reverse the underlying process. (more…)

Alcohol Awareness Week: seeking a responsible alternative


Most of us are aware that chronic, heavy alcohol consumption and binge drinking leads to a plethora of health issues including liver damage and addiction. However, many of us are still unaware of the dangers associated with even moderate alcohol consumption or the cumulative effects that alcohol can have on our health. So just what are those regular trips to the pub, or the frequent cocktails after work really costing us?

Research into effects of alcohol provide a range of results. Some research (funded by the alcohol industry) has even been claimed to demonstrate that alcohol consumption is actually beneficial to our physiological health. Conversely the International Agency for Research into Cancer has demonstrated that the more alcohol you drink directly increases the risk of seven common cancers including: mouth, throat, oesophageal, larynx, breast, liver and bowel.

Similarly, new research published in the British Medical Journal has revealed a potential link between moderate drinking and shrinkage of the hippocampus, a brain region associated with memory. These results suggest a link between moderate alcohol consumption and a potentially permanent alteration in brain structure. (more…)

The Pathology Museum’s top treasures

Tucked away in Charing Cross Hospital is Imperial’s best-kept secret: The Pathology Museum. Housing a 2,500-strong collection of anatomical specimens, the Pathology Museum contains some rare and unique artefacts dating from 1888, including the first hysterectomy performed in England.

Carefully curated by the Human Anatomy Unit (HAU), the specimens are grouped together based on organ systems, creating a well-arranged display of human pathology. The museum’s primary function is to help educate medical and biomedical students to diagnose diseases. The museum also hosts a number of conference and short courses in pathology for experienced professionals.

The collection incorporates specimens from across the Faculty of Medicine’s founding medical schools, there are an astonishing 4,000 further specimens not on display. This vast archive provides a snapshot of the historical foundations of the medical school. (more…)

Understanding our achy breaky hearts

Broken heart syndrome, officially known as takotsubo syndrome, is an acute type of heart failure, where the bottom of the heart stops beating in situations of extreme stress. A condition predominantly affecting post-menopausal women, it has been dubbed broken heart syndrome owing to the frequent occurrence during bereavement after the loss of a loved one. However, this is just one example of the various circumstances in which takotsubo syndrome can occur. Indeed, any stressful event can lead to a surge in adrenaline which can result in takotsubo syndrome. This could be physical or emotional, and includes trauma such as car accidents, drug abuse, and even happy events such as weddings!

This varied list of triggers and the association with a ‘broken heart’ has attracted interest from the media. Furthermore, the specific localisation of the poorly contracting region of the heart and patient demographics are also very interesting from a research standpoint. Often when describing my PhD, the concept of a ‘broken heart’ understandably resonates with people. (more…)

World Polio Day: edging closer to eradication

Imagine you are running a marathon. You have reached the final mile of a long and arduous journey. You turn the last corner expecting to see the finish line, and instead you see a huge vertical ascent. The finish line is waiting at the top, hundreds of metres above you.

Such is the plight of the Global Polio Eradication Initiative. In 1988, the year the initiative was launched, polio paralysed an estimated 350,000 people worldwide – roughly 1,000 each day. Over the last three decades, a globally coordinated vaccination campaign has fought the disease back to a few remaining refuges in Afghanistan, Pakistan, and Nigeria. In 2017, wild poliovirus has caused just 12 cases so far.

As we mark the fifth annual World Polio Day, the finish line of the eradication marathon is firmly in sight, but getting there will be a tough climb.

Why has polio proven so hard to vanquish? First and foremost, the disease’s final strongholds are regions of immense political unrest, and news of deadly attacks against vaccination workers are all too familiar. Every step towards polio’s eradication is one that requires those at the front line to put their lives at risk. (more…)