It is always difficult, and is a necessarily subjective process, to cull from various sources and limit the detail while offering such coverage.
The official sources for this information (as suggested by the Conference organizers) are:
- The Live Conference Blog
- News Releases
- Clinical Care Options
- Rapporteur summaries
For more in-depth information on these and other subjects arising from this Conference, please visit: http://www.ias2009.org/
This Newsletter summary will continue daily through and including Thursday, July 23rd.
OPENING HIGHLIGHTS:
HAART as Prevention
“The added preventive benefit of antiretroviral therapy represents a compelling new rationale for the re-invigoration of HIV treatment roll-out and gives further urgency to the need to avert disruptions in access to life-saving medicines,” said IAS President Dr. Julio Montaner, who is IAS 2009 Chair and Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. “By reducing HIV transmission, as well as morbidity and mortality, treatment scale up is not only the right the thing to do for humanitarian and public health reasons; it is also a cost averting intervention, which makes fiscal sense in these difficult times.”
In addition to these remarks, above, Dr Montaner also said the following:
"Earlier this month, another G8 Summit came and went. HIV/AIDS was indeed the elephant in the room. In 2009 the eight most powerful economies in the world left HIV off their priority agenda. They parted with no progress report on HIV, and they even failed to renew their prior commitments to the goal of universal access to HIV, prevention, care and treatment by 2010. This is totally unacceptable. This is a tragedy."
"HAART is no longer viewed as just a cost-effective intervention that prolongs the life of a person living with HIV or AIDS. HAART is now additionally viewed as an essential tool to curb the growth of the epidemic."
Importantly too, Montaner re-emphasised the importance of not compromising human rights (and protections for marginalised communities such as MSM, IDU and sex workers) in the process of providing treatment and care to people with HIV.
In his plenary remarks, Dr. Reuben Granich, Medical Officer for HIV/TB in the HIV/AIDS Department of the World Health Organization (WHO), examined the significant promise of the use of HAART as part of a combined approach to HIV prevention that includes behavioral, structural and biomedical prevention interventions. Dr. Granich outlined the context and basic assumptions regarding this emerging strategy, including when to start ART for maximal clinical and prevention benefit. He also highlighted the essential roles of human rights, dignity and community engagement in the use of HAART for prevention and discussed the outstanding biological, feasibility, impact and cost issues related to research in this arena [emphasis added].
HIV and Host Genetics
Dr. Amalio Telenti discussed the relatively new field of HIV and host genetics, examining the role of host genetics in susceptibility to HIV-1 disease, plasma drug levels and treatment toxicity. Dr. Telenti, Professor of Medical Virology and Director of the Institute of Microbiology at the University Hospital Center of the University of Lausanne, Switzerland noted that despite some false starts, there is now solid data in this arena, including a thorough understanding of the role of common human genetic variation in HIV disease progression and drug toxicity. He said that we can now explain 22% of population variance in viral load by genetics, population effects, gender and age. He thought that it won’t be long before there are useful predictive pharmaco-genomic strategies to predict toxicities of certain antivirals and to allow for the creation of optimal treatment regimens for individuals [emphasis added].
Prevention of Mother-to-Child Transmission
Dr. Louise Kuhn called for a mobilization of political will to implement the latest knowledge on prevention of mother-to-child transmission (PMTCT), highlighting data on breakthroughs in PMTCT strategies during breastfeeding, including lactation support and counseling, continuation of maternal HAART after delivery, and extended infant prophylaxis with nevirapine. According to Dr. Kuhn, the urgency of implementing these interventions is underscored by accumulating data on negative impacts of avoiding or shortening the duration of breastfeedign [emphasis added].
The issue of treatment as prevention is set to be a major discussion topic at this Conference and it is important one for community to monitor. Dr Reuben Granich, from the United States, began the plenary saying that if there was universal testing and immediate ART, combined with other prevention interventions, there would be a 95% reduction in HIV cases in 10 years and the incidence would be reduced from 15-20 000 to 1000 cases per million. Prevalence (or the number of people with HIV) would become less than 1% by 2050. Initial resources would be higher but this approach may provide cost savings.
Some interesting quotes:
Hoosen (Jerry) Coovadia (IAS 2009 Local Co-Chair, Chairman of Dira Sengwe and Scientific Director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal):
"HIV is the hand-maiden to tuberculosis."
Kgalema Motlanthe (South African Deputy President):
"Unless we redouble our efforts to conquer this disease it will define the 21st century for sub-Saharan Africa."
Françoise Barré-Sinoussi (2008 Nobel Laureate and IAS Governing Council):
Viral reservoirs constitute the major obstacle to eliminating HIV from the body. Prof. Barré-Sinoussi was expected to explain how HIV – hidden mostly in subpopulations of latently infected resting memory CD4+ T cells – persists by distinct mechanisms in patients treated with highly active antiretroviral therapy. In her remarks, she was to pose some of the most vexing questions facing AIDS scientists and clinicians today, including: What are the main reservoirs of HIV in the body? What are the mechanisms responsible for the establishment and persistence of these reservoirs? Which strategies can be proposed accordingly?
"There is still a very long way to go" in controlling HIV reservoirs.
Stephen Lewis (AIDS Free World Co-Director):
"When, as now, there's a backlash against funding for AIDS, with
mindless charges against AIDS exceptionalism, you should find a way collectively to shoot down the pinched bureaucrats and publicity-seeking academics who advocate exchanging the health of some for the health of others."
"We must never allow them to play one part of the health sector against the other...HIV/AIDS, for all the horrendous human consequences, has objectively strengthened health systems."
"When the G8 won't renew its 2005 commitment to universal access...then it's time for science to speak with one powerful voice of accusation."
"An ugly homophobic culture is a threat to public health that
inevitably serves to spread the virus."
Events which occurred prior to, but that are connected with, the Official Conference Program included:
IAS 2009: 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention – Treatment Action Campaign sponsored a march and rally calling for the resources needed to meet the South Africa National Strategic Plan's targets for HIV/TB treatment and prevention just prior to the opening of the conference on 19, July 2009. One of the loudest cheers went up for a doctor in the public health service who explained why doctors had found it necessary to go on strike about the lack of health care workers to do the tasks required to care for plhiv.
Viyuseka Dabula, General Secretary of Treatment Action Campaign:
“When I need second-line treatment I want a guarantee I can get access to it, “she said. “If we don’t increase the resources available, 90% of the current monies will be needed for second line treatment by 2012.”
Some photographs taken during the first few days include:
Dr Montaner – wearing the Rally shirt “HIV-POSITIVE” – signs a petition
South African Health Minister Dr. Aaron Motsaoledi asks for, and then puts on, an HIV Positive t-shirt in solidarity with activists demonstrating for increased resources for HIV and health services.
Médecins Sans Frontières (MSF) reported on disruptions in supplies of antiretroviral (ARV) drugs in six African countries. Citing the catastrophic consequences of drug shortages on new patients and those already in care, the MSF report called on national governments, donors and their partners to take swift action to address the funding gaps and supply distribution problems hampering access to lifesaving drugs. The six countries cited were the Democratic Republic of Congo, Guinea, Malawi, South Africa, Uganda and Zimbabwe.
US Global AIDS Coordinator Eric Goosby and NIAID Director Anthony Fauci spoke at an IAS 2009 special session entitled, Global HIV Research and Policy and Programme Implementation under the New United States Administration. The session was on Monday, 20 July, from 1:00 – 2:00 pm (local time) and it was chaired by Global Fund Executive Director Michel Kazatchkine.
This is the first major international AIDS conference for Ambassador Goosby, in his role as Coordinator of the President’s Emergency Plan for AIDS Relief (PEPFAR), the US government’s multi-billion dollar global AIDS programme. Dr. Fauci, who has spoken at previous IAS conferences and is always a big draw, discussed US government-funded HIV research. The session was expected to attract a standing room only crowd eager to hear details of the Obama Administration’s plans. Those unable to watch in person can access a free webcast of the session on the conference website.
Dr Fauci:
"Sure" US #HIV travel ban will be lifted. Everyone I have talked to in the Obama Admin supports lifting ban.
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