User:Colebunders/sandbox

Robert Colebunders, MD, PD Prof Infectious Diseases, Global Health Institute, University of Antwerp, Belgium

Professional activities

1974: Setif, Algeria: As young medical doctor responsible for the department of pediatrics in large city hospital.

1974 -75: Bougaa, Algeria: responsible for the health care of a large rural area.

1982- 84: Senior fellow in Internal Medicine, University Hospital Antwerp and Hospital St.-Mariagasthuis, Berchem, Belgium.

1984- 87: Coordinator of the clinical studies on HIV/AIDS of "Projet SIDA" in Kinshasa, Zaire.

1988: Visiting scientist, International Activities HIV/AIDS program, Centers for Disease Control and prevention (CDC), Atlanta, Georgia, USA.

1989-99: Coordinator of the HIV/AIDS patient care and clinical research, Institute of Tropical Medicine, Antwerp.

Since 1995-2004: Professor in Tropical Diseases and STD, Institute of Tropical Medicine, Antwerp.

Since 1996: Professor in Infectious Diseases, University of Antwerp.

2004-2005: Senior consultant (sabbatical) at the Infectious Disease Institute, Academic Alliance, Uganda

May 2014-17: Emeritus professor tropical diseases Institute of Tropical Medicine, Antwerp

October 2015: Professor Infectious diseases, Global Health Institute, University of Antwerp

2018 Council Member International Society of Infectious diseases (ISID)

Scientific contributions in the control of different major epidemics.

1. HIV and tuberculosis (TB) R Colebunders was the first to systematically describe the clinical manifestations of HIV in Africa. He reported the high positive predictive value of a papular pruritic eruption, Herpes Zoster and chronic diarrhoea for the diagnosis of HIV infection. He was the first to describe bilateral parotid gland swelling as a manifestation of HIV infection in adults. These findings achieved international prominence at the first WHO meeting on AIDS in Bangui in 1985. At this meeting mainly based on his findings the first WHO clinical case definition of AIDS for adults and children was promulgated. Subsequently, he was the first to evaluate these definitions. In the early days of the HIV epidemic, when HIV testing was not yet widely available, these case definitions were very useful to identify patients suspected to have AIDS and to numerate the number of AIDS cases in surveillance programs in resource limited settings. In 1992, he was the chairman of a WHO expert meeting that developed the WHO clinical staging system for HIV infection. Subsequently he evaluated this staging system. This staging system has been extremely useful as a prognostic marker in clinical studies and as a way to identify HIV-infected patients in need of antiretroviral treatment. He was a co-investigator in many initial HIV epidemiological studies that documented the HIV disease burden in Africa and the natural history of HIV infection before the introduction of antiretroviral agents. In 1985, at a time when it was not yet clear if HIV could be transmitted through breast feeding, in the Democratic Republic of the Congo (DRC) he described a child who became infected through breast feeding by a wet nurse. This case added further evidence for the transmission of HIV through breast feeding. He was the first to describe the strong link in Africa between HIV and TB and to document the clinical characteristics of patients co-infected with TB and HIV. In sentinel publications, R Colebunders was among the first to describe patients with HIV related Immune Reconstitution Inflammatory syndrome (IRIS). Under his coordination a case definition of TB IRIS and of cryptococcal IRIS were developed. These definitions are now used worldwide in all studies on IRIS. He was among the first researchers to advocate for the access to antiretroviral treatment (ART) in countries with limited resources. In several publications he reported on the challenges of rolling out such treatment but showed, with others, that rolling out such treatment in resource poor countries would be feasible and effective. In 2005 he showed that most antiretrovirals penetrate well in breast milk and that by using ART during breast feeding the viral load becomes undetectable in the breast milk. He co-authored numerous studies about how to improve the quality of care in persons with HIV and HIV TB co-infection and how to organize care/treatment more effectively. Together with his PhD student J Cox, he showed that despite ART opportunistic infections such as TB and cryptococcal meningitis remain the main causes of death in persons with HIV infection and that with partial autopsies using needle biopsies in the majority of patients with HIV infection the cause of death can be determined. C Kenyon, another of his PhD students, described a new opportunistic dimorphic fungal infection (initially called Emmonsia) in patients with HIV infection in Cape Town. I Schwartz, also his PhD student, further studied the clinical and epidemiological characteristics of this fungus that recently was renamed Emergomyces Africanus.

2. Filovirusses R Colebunders was a member of the international team that investigated and controlled in 1995 the Kikwit Ebola outbreak (the first Ebola outbreak after the initial outbreak in 1976) and the 1999 Durba Marburg outbreak (the first Marburg outbreak in Africa), He also reviewed in Conakry, the clinical care activities of Doctors Without Borders during the West African Ebola outbreak. His work contributed to a better knowledge of the clinical manifestations of filovirus infections and the management of these infections.

3. Nodding Syndrome and onchocerciasis associated epilepsy (OAE) Since 2014, R Colebunders is engaged in research to identify the cause of the nodding syndrome, an until then mysterious type of epilepsy known to occur only in northern Uganda, South Sudan and Tanzania. He discovered that nodding syndrome is only one of the clinical presentations of epilepsy caused by onchocerciasis (river blindness), currently called onchocerciasis associated epilepsy (OAE). He reported prevalence rates of epilepsy in villages with high onchocerciasis transmission in the DRC, Cameroon, Uganda, Tanzania and South Sudan varying between 2 and 10%, while the median prevalence of epilepsy in non-onchocerciasis endemic regions in Africa is 1.4%. He documented that in such villages ivermectin distribution once a year is insufficient to seriously decrease the incidence of OAE and that bi-annual distribution of ivermectin should be preferred. In collaboration with the team of M Boussinesq, he showed in a prospective study in Cameroon that the risk to develop epilepsy increased with increasing skin microfilarial density during childhood. In a recently completed randomized clinical trial in Ituri the DRC he showed that ivermectin is able to reduce the frequency of seizures in persons with OAE. His reseach showed that OAE is a major neglected public health problem and that probably about 400.000 persons are currently affected by this form of epilepsy. Most importantly he showed that this type of epilepsy can be prevented by more effective onchocerciasis elimination programs. In Kabarole district in Western Uganda he showed, in an area where before the implementation of onchocerciasis control measures there had been a high prevalence of epilepsy, OAE and including nodding syndrome stopped to appear since onchocerciasis was eliminated from the area. Currently Dr Colebunders is performing research to identify the pathophysiology of OAE by performing a postmortem study in northern Uganda, and is setting up interventions to prevent OAE in Ituri, DRC (evaluating the effect of Moxidectin) in Maridi, South Sudan (by introducing bi-annual ivermectin treatment) and in Mahenge, Tanzania (by bi-annual ivermectin together with larviding rivers). Moreover with African partners he is developing a decentralised system for epilepsy treatment and care in remote African onchocerciasis endemic regions.

Selected peer-reviewed publications (selected from 642 publications) 1.	Colebunders R, Mann JM, Francis H et al. Evaluation of a Clinical Case Definition of AIDS in Africa. Lancet 1987; i: 492 4. 2.	Colebunders R, Lusakumunu K, Nelson AM et al. Persistent diarrhoea in Zairian AIDS patients: an endoscopical and histological study. GUT 1988; 29: 1687-91. 3.	Colebunders RL, Ryder RW, Nzilambi N, Dikilu K, Willame JC, Kaboto M, Bagala N, Jeugmans J, Muepu K, Francis HL, Mann JM, Quinn TC and Piot P. HIV infection in patients with tuberculosis in Kinshasa, Zaire. Am Rev Respir Dis 1989; 139: 1082-5. 4.	Colebunders R, Hodossy B, Burger D, Daems T, Roelens K, Pelgrom J, Coppens M, Van Bulck B, Jacquemyn Y, Van Wijngaerden E, Fransen K. The effect of highly active antiretroviral treatment on viral load and antiretroviral drug levels in breast milk. AIDS. 2005 Nov 4;19(16):1912-1915. 5.	Colebunders R, Tshomba A, Van Kerkhove M, Bausch D, Libande M,  Pirard P, Tshioko F, Mardel S, Mulangu S, Sleurs H, Rollin P, Muyembe-Tamfum J-J, Borchert M. Marburg Haemorrhagic Fever in Watsa, Democratic Republic of Congo: Clinical Documentation, Symptomatology and Treatment. J Infect Dis 2007; 196: S148-S153 6.	Colebunders R, Tepage F, Rood E, Mandro M, Abatih EN, Musinya G, Mambandu G, Kabeya J, Komba M, Levick B, Mokili JL, Laudisoit A. Prevalence of River Epilepsy in the Orientale Province in the Democratic Republic of the Congo. PLoS Negl Trop Dis. 2016 May 3;10(5):e0004478. doi: 10.1371 7.	Colebunders R, Mandro M, Mokili JL, Mucinya G, Mambandu G, Pfarr K, Reiter-Owona I, Hoerauf A, Tepage F, Levick B, Begon M, Laudisoit A. Risk factors for epilepsy in the Bas-Uélé Province in the Democratic Republic of the Congo: a case control study. Int J Infect Dis. 2016 May 19. pii: S1201-9712(16)31061-X. doi: 10.1016/j.ijid.2016.05.018. 8.	Colebunders R, Nelson Siewe FJ, Hotterbeekx A. Onchocerciasis-Associated Epilepsy, an Additional Reason for Strengthening Onchocerciasis Elimination Programs. Trends Parasitol. 2017 Dec 26. pii: S1471-4922(17)30283-0. doi: 10.1016/j.pt.2017.11.009. 9.	Colebunders R, Abd-Elfarag G, Carter JY, Olore PC, Puok K, Menon S, Joseph Nelson Fodjo Siewe JNF, Bhattacharyya S, Ojok M, Lako R, Logora MY. Clinical characteristics of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan. Seizure DOI 10.1016/j.seizure.2018.10.004 10.	Colebunders R, Carter JY, Olore PC, Puok K, Bhattacharyya S, Menon S, Abd-Elfarag G, Ojok M, Ensoy-Musoro C, Lako R, Logora MY. High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: a community-based survey. Seizures 2018 Dec;63:93-101.