By Dr. Paul Benson
MALAYSIA –The 7th International AIDS Society’s (IAS) Conference on HIV Pathogenesis, Treatment and Prevention ended July 1 after five days of intense presentations and discussions. The conference took place at the Kuala Lumpur Convention Center in Malaysia. This year did have fewer attendees than the previous years I have attended, perhaps because of distance. There were 5,220 participants from 127 countries. This was the first international HIV conference to be held in a Muslim country.
There was great optimism for the scientific progress made in managing HIV. This optimism was mixed with the concern that the progress isn’t yet translating to reduced infections, especially in key populations around the world. Discussion is now concentrating on the multiple co-morbidities associated with HIV and the reasons why they co-exist. These co-morbidities such as hypertension, cardiovascular disease, diabetes, neurological disorders, osteoporosis, kidney disease, malignancies, and more can be overwhelming for a person living with HIV. These same co-morbidities can alter the normal aging process in infected individuals. Our search for the complete understanding of the causes of these co-morbidities has begun.
The first plenary session of the conference came from Mean Chhi Vun, a Director of Health in Cambodia. He reviewed Cambodia’s response to HIV over the last 2 decades. Cambodia has been one of the few Asian countries to reverse the trend of HIV acquisition. They accomplished this amazing feat with an open and undiscriminating approach of identifying positive individuals with an aggressive testing program. They focused attention in the same non-discriminating way on unprotected sex workers. The last and final phase of a planned strategy was a program of assuring continuity of care for those infected. Cambodia is on track to achieve the elimination of new HIV infections in their country by 2020. What a remarkable presentation to start the conference
Another plenary session presented by Linda-Gail Bekker, Director of the Desmond Tutu HIV Center in South Africa, reviewed the challenges facing young people with HIV as they transition from adolescence to adulthood. Specific issues included changing medical providers from the pediatric to the adult provider was reviewed. Adolescents also have complex issues when it comes to HIV disclosure to others and adherence to taking medication correctly. Transition to adulthood from adolescence has already been described for other chronic illnesses, however HIV is unique due to the many associated stigma attached to it. Many adolescents fall out of care at this sensitive time in their lives and as expected that has deleterious consequences.
Attendees were reminded of the current legal and regulatory actions around the world, including the United States, that are actually undermining prevention and treatment efforts. According to Aziza Ahmed of the United States, the fear of prosecution and incarceration often encourages HIV positive individuals to stay underground rather than seek help. Effective and high quality care, treatment, and comprehensive services are needed in an environment that does not discriminate, stigmatize, and marginalize the very people who need that support and care. This is crucial for both the individual and public health reasons.
Daniel Douek, from the United States National institute of Health, gave an amazing presentation on immune activation, its persistence in HIV positive individuals, and the consequences of it. He gave a multitude of examples using macaque monkey research to make his points. Currently in clinical practice we treat the virus and are quite successful with that. However we do little to manage the damaging chronic immune activation affects. This treatment is critical to reduce the co-morbidities that relate to HIV and interfere with the normal aging process. This immune activation inhibiting therapy would be in addition to the current standard of care HIV antivirals. He demonstrated through his research that even with excellent virologic suppression, immune activation persists. There will certainly be more come on this hot new topic in HIV.
There were many presentations on prevention. In abundance were presentations on pre and post exposure prophylaxis using topical, oral, and injectable preparations. Assuming eventual approval of many of these compounds, the user will have to make important choices about the best approach for them. There will be many alternatives. Whichever one is chosen, the important point is that they will need to be used correctly. Current research has indicated that with what we have available, that has not always been the case.
There is a great amount of commonality between HIV and Hepatitis C. They’re both basically transmitted the same way. Often individuals are co-infected with both diseases at the same time. The health strategy for managing these illnesses are the same. “Seek…Test…Treat…and Retain.” The difference is that in the near future there will be new treatments for Hepatitis C so we can add “Cure” to that paradigm. It’s becoming a very exciting and optimistic time for hepatitis C management.
The amount of scientific and clinical information presented at this conference would fill a book. There were many great poster and oral presentations on a variety of topics from pharmaceuticals to social policy. The next two international conference dates and venues were announced. The World AIDS Conference will be in Melbourne,,Australia July 20-25,2014 and the 8th IAS conference will be in Vancouver, British Columbia, Canada July 19-22, 2015. International HIV conferences provide a setting of high energy and networking from a passionate world community committed to the betterment and eradication of HIV.