Bay Area Reporter - August 2, 2007
Liz Highleyman, liz@black-rose.com

The IAS conference, which alternates every other summer with the International AIDS Conference, has traditionally focused more on the medical management of HIV disease.

While there were no major new treatment breakthroughs announced in Sydney, the overall mood was upbeat due to continued incremental improvements in therapy.

At the retrovirus conference in February, researchers announced promising results for two antiretroviral drugs from entirely new classes - the CCR5 inhibitor maraviroc (Celsentri) and the integrase inhibitor raltegravir (Isentress) - in highly treatment-experienced patients with extensive drug resistance. In Sydney, it was reported that both drugs also work well in people starting treatment for the first time.

With today's better drugs, experts are again discussing the benefits of early therapy. This approach was popular in the late 1990s, but fell out of favor due to unexpected long-term side effects. Today, however, the pendulum appears to be swinging back.

Conference co-chair Dr. David Cooper of Australia's National Centre in HIV Epidemiology and Clinical Research reignited another old debate when he suggested that new therapies might be able to completely eradicate the virus.

"Eradication was talked about when antiretroviral therapies became available in the mid-1990s, but went off the agenda because of the toxicity of the drugs," he said. "Now, with some of the newer drugs and newer strategies, it's back on the agenda again."

But Dr. Anthony Fauci, with the National Institute of Allergy and Infectious Diseases, who spoke at the conference's opening session on July 22, sounded a less optimistic note.

"You can stop [HIV] multiplying and keep someone quite well for many, many years," he told reporters. "But so far we haven't even come close to truly eradicating it in anyone."

But such debates remain largely irrelevant in developing countries, where millions of people with HIV/AIDS still go without needed treatment.

According to "Missing the Target #4," a new report from the International Treatment Preparedness Coalition released on July 18, wealthy country governments and international donors are failing to provide free or low-cost anti-HIV drugs for all who need them throughout the developing world.

"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 IAS President Dr. Pedro Cahn. "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."

On the prevention front, more data support adult male circumcision as part of a comprehensive HIV prevention strategy. But women-controlled prevention technologies have seen recent setbacks, including a higher rate of new HIV infections in a large trial of the UsherCell vaginal microbicide and no protective benefit in a recent study of cervical diaphragms.

While much attention has focused on HIV-positive women and children in poor countries, men who have sex with men still account for a large proportion of people living with or at risk for AIDS worldwide. But these men are often ignored, marginalized, or subject to violence due to the stigma surrounding homosexuality in many parts of the world.

To address this issue, the American Foundation for AIDS Research this week launched a new initiative to reduce the spread of HIV among MSM in developing countries.

"For too long, squeamish and homophobic governments have failed to provide even the basic tools for MSM to protect themselves from HIV," said AmFAR's Kevin Frost. "Only one in 20 MSM globally have access to appropriate services."

To redress this shortcoming, the new initiative - funded in part by Elizabeth Taylor and the MAC AIDS Fund - will work to empower local grassroots organizations, advocate for better policies, and research gaps related to MSM, many of whom may not self-identify as "gay" or "bisexual."

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