The 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention has opened in Sydney in a mood of hope and excitement. Speakers at the opening press conference emphasised recent advances in the conference’s three areas of focus: the basic science of HIV; antiretroviral therapy; and prevention technologies.
Over 5,000 delegates, many from low- and middle-income countries hardest hit by HIV, have registered for the conference.
Delegates have been asked to sign up to a declaration urging funders of treatment and prevention programmes to provide an extra 10% to pay for research.
Expanding access to therapy
Speakers at the opening ceremony committed to expanding access to anti-HIV therapy in settings where it is most required.
Dr Michel Kazatchkine of the Global Fund to Fight AIDS, TB and Malaria, told delegates that over 2.2 million individuals are now taking potent antiretroviral therapy in poorer countries. He contrasted this to the 200,000 or so patients in resource-limited countries who were taking effective HIV treatment in 2001 when the first IAS conference was held. The number of people taking therapy today was, he said, beyond his “wildest expectations” in 2001.
Yet a real sense of realism was also present. IAS chair, Dr Pedro Cahn, said that even though HIV was a preventable and treatable condition there were still 1,000 new HIV infections every day and three million deaths caused by HIV every year.
Advances in each of the conference’s key areas
There are three themes to the IAS’s biennial conference – HIV pathogenesis, treatment and prevention, and Dr Tony Fauci, of the US National Institutes for Health, said that there had been had been significant recent developments in all three areas.
He told delegates that an improved understanding of the basic science of HIV was allowing the development of an ever-expanding arsenal of antiretroviral drugs, with novel classes of drugs now able to target HIV’s entry into human cells.
Furthermore, research showing the extent of the irreparable damage HIV causes to lymphoid tissue in the gut soon after infection was, Dr Fauci said, helping inform the continuing debate on the optimum time to initiate antiretroviral therapy. But he added that there needs to be a body of robust data demonstrating the advantage of earlier treatment before current antiretroviral therapy guidelines are changed. It was, however, clear that he believes such data are accruing.
Dr Fauci described currently available anti-HIV therapy as “extraordinary”, but said that it was important to ensure that there remained a pipeline of new therapies. Although he was encouraged by expanding access to HIV therapy in poorer countries he told delegates that only 28% of those who needed HIV drugs in resource-limited setting were receiving them. Dr Cahn described this situation as a “shameful failure.”
Biomedical prevention technologies, most notably male circumcision, were also mentioned in enthusiastic terms. But Dr Fauci emphasised that circumcision was an adjunct, not a replacement for other “scientifically proven” methods of prevention. He also highlighted recent evidence showing that only a fifth of individuals at risk of HIV have access to effective prevention. If HIV prevention programmes that are known to work were more widely available, Dr Fauci said that 50% of projected new infections could be avoided.
Much still to do
Delegates were also told of the significant obstacles that mean that HIV treatment is not reaching the majority of those who need it. Dr Kazatchkine said that even though PEPFAR and the Global Fund could point to some impressive achievements, there are still insufficient resources – both financial and physical – to meet demand.
Although Dr Fauci believed that advances in the understanding of HIV in the quarter of a century since the first cases of AIDS were diagnosed should be “celebrated”, he also said that the next 25 years will determine how the world’s response to HIV is judged.
Sydney Declaration
To help ensure that the verdict is favourable, delegates to the conference are being asked to sign up to the “Sydney Declaration”, which calls on donors and funders to provide an additional 10% in resources to pay for research. Professor Sharon Lewin, of the Australasian Society of HIV Medicine, said that this research was essential to ensure that effective prevention and treatment programmes were developed and delivered.
Australia and HIV
Prof. Lewin also talked with pride about Australia’s response to HIV, noting researchers, clinicians, community groups and government had worked together in response to the epidemic. Ironically, the Sydney conference is taking placed just as this partnership appears to be fracturing. The Australian government is proposing to introduce very tight immigration restrictions on people with HIV. The IAS felt compelled to condemn these proposals in the run-up to the conference and delegates at the opening ceremony were told of the continuing stigma that surrounds HIV.