Thousands of scientists, healthcare providers, and community leaders have gathered in Sydney, Australia, for the fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007). Sunday's opening session began with calls for even greater vigilance to ensure universal access to HIV prevention and treatment, along with an expansion of research to inform and strengthen the global response to HIV.
Setting the Stage
"With fewer than one third of people living with HIV in low- and middle-income countries having access to life-saving medications, and still fewer with access to proven prevention services, such as condoms and sterile syringes, the goal of universal access by 2010 must remain a priority," said conference cochair Pedro Cahn, MD, of Argentina in his opening remarks. "Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice is a shameful failure."
Emphasizing that "good research drives good policy and programming," Sharon Lewin, PhD, of the Australasian Society of HIV Medicine spoke of the Sydney Declaration, a global sign-on letter urging governments and donors to allocate 10 percent of all resources dedicated to HIV programming for research.
"It is our responsibility as researchers, as the drivers of the research locomotives that carry HIV treatments forward, to ensure that clinical and prevention research, as well as capacity building and basic science, continue to thrive in the most affected countries," said David Cooper, MD, local co-chair of IAS 2007 and director of the National Center in HIV Epidemiology and Clinical Research at the University of New South Wales in Sydney.
Global Access to Care and Treatment
Michael Kazatchkine, MD, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria delivered the first keynote lecture of the evening, reviewing advances in the global response to AIDS over the last 15 years. His lecture focused on the growing prominence of health on the international development agenda, the demonstrated feasibility of scaling up treatment in resource-constrained settings, new opportunities for HIV prevention, and the global mobilization of civil society.
While Dr. Kazatchkine reminded delegates that only 28% of the global HIV population in need of treatment has access to antiretrovirals, the fact that 2 million people in low- and middle-income countries were receiving therapy in 2006—compared to a meager 300,000 people in 2002—is an undeniable sign of progress.
Looking forward, Dr. Kazatchkine outlined the major challenges that need to be overcome if the promise of universal access to HIV prevention and care is to be achieved. Of note, there is a need for sustainable financing and strategies to address the health workforce crisis.
Much Accomplished, Much to Do
In the second plenary of the evening, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health in Maryland, took stock of the accomplishments in the areas of HIV pathogenesis, treatment and prevention.
Dr. Fauci reviewed recent advances in understanding the disease-causing mechanisms of HIV, focusing specifically on research showing that HIV causes significant damage to lymphoid tissue in the gut—very soon after infection is established in the body—that irreversibly damages the immune system.
Building upon this knowledge, he said, it will be necessary to develop new interventions. One possibility is the initiation of antiretroviral treatment early in the course of HIV disease. He stressed, however, that a great deal of research will first need to be completed, before existing treatment guidelines return to the days of "hit hard, hit early."
Dr. Fauci also reviewed milestones in treatment research over the past decade, including the astonishing headway that has been made in developing entirely new classes of drugs, including inhibitors of HIV entry, integrase, and maturation. But such developments must continue, he said—“a pipeline of new therapies needs to be maintained.”
Dr. Fauci also discussed progress and priorities in HIV prevention, both the importance of scaling up proven prevention strategies and the critical need to develop new prevention tools such as topical microbicides.
As for vaccines, Dr. Fauci said their “development may diverge from the classic paradigm for other viral vaccines. There is optimism that even a less-than-perfect vaccine could benefit both individual recipients and the much larger community.” He explained that a vaccine doesn’t necessarily need to prevent someone from becoming infected, but rather spark a strong enough immune response to keep viral load controlled—thus reducing the risk of the infection being spread to someone else and potentially slowing the rate of disease progression—if transmission occurs.
A one-on-one AIDSmeds.com videocast interview with Dr. Fauci, highlighting his keynote lecture and other noteworthy topics, is now available.
The Conference Ahead
Over 5,000 delegates from 133 countries are attending this year’s conference. Some of the many important scientific findings to be presented and discussed at the conference include:
- The development of novel treatments that offer new hope to persons in whom HIV has developed resistance to existing medications.
- New biomedical prevention strategies available and others on the horizon, such as female-controlled microbicides, male circumcision and the use of pre-exposure prophylaxis (PrEP).
- New knowledge of HIV pathogenesis and the mechanisms through which HIV causes immune deficiency.
- Operations research detailing what we've learned, to date, about what is working on the ground in communities across the globe.
- Updates on the clinical implications of an aging population of people living with HIV, as well as on pediatric treatment issues.
Keep your eyes on AIDSmeds.com and POZ.com for written reports and videocasts highlighting these and other developments from Sydney.
