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XVIII International AIDS Conference July 18-23, 2010, Vienna, Austria
Introduction
At the end of July, researchers, policy makers and all those interested in seeing the end of the HIV pandemic gathered in Vienna, Austria for the International AIDS Conference1.
The conference took place over a week and covered various topics related to HIV including:
- Basic Science
- Clinical Sciences
- Epidemiology and Prevention Services
- Social and Behavioural Sciences
- Economics, Operations, Research, Care and Health Systems
- Policy, Law, Human Rights and Political Science
These were divided into various types of sessions such as symposia, workshops and abstract-driven sections (both oral and poster presentations).
Highlights
Presented at the conference were the new Guidelines for ART by International AIDS Society USA (IAS-USA) that HAART should be started at a CD4+ cell count of less than 500 cells/mm3. The new recommendations also include preferred agents for first-line therapy and their preferred alternatives.
Results from the CASCADE cohort study by Funk et al. presented results that calculated the risk of AIDS and death through using CD4+ T cell counts as soon as ART is started. Researchers found a relatively small increase in risk among patients who had CD4+T cells counts between 350 and 499 cells/ųL and urge healthcare providers to carefully consider the risks and benefits of starting these patients on HAART (Abstract THLBB201).
Some randomised, double-blind phase III trials were presented for new drugs with which treatment-naive patients could be treated. These include:
The SPRING-1 study by Arribas J et al. which demonstrated potent antiviral activity with a next-generation HIV-1 integrase inhibitor used as a once-daily, unboosted treatment (Abstract THLBB205).
Cohen et al. presented pooled data from two double-blind, randomised phase III trials. These results proved to be among the highest observed response rates for treatment-naive trials (Abstract THLBB206).
The VERxVE study by Gathe et al. studied the efficacy of an extended release Nevirapine; using a once-daily dosage in comparison with the more traditional immediate release formulation. They found that the once-daily dose was as effective as two doses a day (Abstr THLBB202).
The PROGRESS study by Reynes L et al. showed that the novel NRTI-sparing regimen of Lopinavir/ritonavir combined with raltegravir had as high efficacy as a traditional antiretroviral regimen that makes use of 3 drugs. (Abstract MOAB0101).
Mills et al. presented results from a study that compared the safety and immunoviological activity of a once-a-day maraviroc combined with a ritonavir booster with emtricibine/tenofovir (also boosted with atazanavir). They found that the simpler nucleoside sparing regimens were active and well-tolerated and suggested further trials to study this combination of drugs (Abstract THLBB203).
The SPARTAN study presented by Kozal et al. was a pilot study assessing the safety and efficacy of a new NRTI and ritonavir-sparing regimen using atazanavir and raltegravir. The efficacy rates of this regimen were consistent with current standards (Abstract THLBB204)
The SENSE trial, using etravine showed fewer adverse neuropsychiatric adverse events than efavirenz. (Gazzard et al., Abstract LBPE19).
Switch studies:
The MONET trial analysed darunavir/ritonavir(DRV/r) monotherapy vs. DRV/r +2NRTIs in patients with less than 50 copies/ml of HIV RNA at baseline. The switch to DRV/r monotherapy was shown to be as efficient as DRV/r+2NRTI. (Riger et al., Abstract THLBB209).
Studies for drugs to be used on treatment-experienced patients, such as the initial results of the VIKING study by Eron, J et al., showed that a next-generation integrase inhibitor could be used in patients who were showing a high level of resistance against raltegravir. (Abstract MOAB0105).
When it came to studying co-infections, two sudies stood out:
The quadrivalent (human papillomavirus) HPV vaccine proved to be effective in preventing external genital lesions in men. ( Jessen et al., Abstract THLBB101).
The CAMELIA trial concluded that there is a significant improvement in the survival rate of patients co-infected with TB and HIV when highly active antiretroviral treatment is started early. (WHO, Abstract THLBB106).
Caprisa 004
One of the major news items was the positive results from the CAPRISA 004 research which used Tenofovir Microbicide Gel to prevent the transmission of HIV to women.
An entire session was dedicated to reporting the various results from this trial, with the Health Minister of South Africa, Dr Aaron Motsoaledi, also giving a talk on contextualising the results in the field of HIV.
The main conclusions drawn from this two-arm, double-blind, randomised, placebo-controlled trial were that more HIV-women presented detectable concentrations of 1% Tenofovir (TNF) in genital tract secretions and blood compared to those women who had seroconverted, making it plausible that the TNF had prevented them from seroconverting. This vaginal microbicide showed an efficacy of 40-50% in the prevention of HIV.
This provides women who are unable to negotiate safe sex or monogamous partnerships with an alternative of protecting themselves from being infected and could prevent up to 602 000 new infections in ten years, provided high levels of coverage are maintained.
Tenofovir has a good safety profile and although it is rapidly absorbed in the genital tract, it has a low systemic absorption and fewer expected side-effects. This trial provided proof of concept for using antiretrovirals as prophylactics as well as proof of concept for micobicides’ use in the prevention of HIV transmission.
Conclusion
Almost 20 000 people attended this conference. It brought together some of the best scientists doing research in the field of HIV, and the basic sciences received some of the best collections of abstracts.
The CAPRISA 004 study presented an important step towards using ARVs as prophylaxis and the usefulness of a microbicide to prevent infection. This is especially important in Africa where women are very vulnerable to contracting HIV. This study has opened the doors for many more studies on similar topics.
References:
- AIDS 2010 - Vienna 18-23 July 2010 - XVIII International AIDS conference Home. at <http://www.aids2010.org/>
Author: Marike Kotzé
Reviewed by: Jean Fourie
Contact: afroaidsinfo@mrc.ac.za
Date: September 2010
Last updated: 3 September 2010
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