United Press International - Friday, 14 July 2000
Michael Smith, UPI Science News

"I'm very angry with many of my colleagues," said Stefano Vella of Rome, the new president of the International AIDS Society (IAS), which runs the biennial conferences. "It was a mistake not to come."

The conference drew 12,700 delegates from 184 countries, ranging from Afghanistan from Zimbabwe, officials said. In contrast, the 1998 conference, held in the Swiss city of Geneva, drew more than 17,000 delegates.

Vella said many people didn't come to the conference because of fears about security. Other found the long travel times daunting -- flying from New York to Durban takes more than 15 hours.

He added those concerns were not a sufficient justification: "If you are working on AIDS, you have to be here."

Former IAS president Mark Wainberg of Canada called the conference an "unbridled success," in terms of raising awareness of the extent of the AIDS epidemic. More than 34 million people worldwide are infected with HIV, the virus that causes AIDS, and 24.5 million of those are in sub-Saharan Africa.

But Wainberg said some of the scientific aspects of the conference were disappointing. "We've done a great job here in regards to scientific relevance on the community level, the behavioral science level and indeed the social aspects and ethics of HIV research," he said.

In contrast, he said the basic science and clinical research tracks were less extensive than at past conferences, at least partly because many scientists from the developed world stayed home. "We have to be honest about this," he said.

Despite flaws, though, the meeting was "an extraordinary conference and an extraordinary human experience," said Helen Gayle, director of the National Center for HIV, STD and TB Prevention of the Centers for Disease Control in Atlanta.

The meeting began under a cloud of controversy: South African President Thabo Mbeki, who had questioned the role of HIV in causing AIDS, was challenged on the eve of the conference by an extraordinary declaration signed by 5,000 scientists around the world.

The so-called "Durban Declaration" said that the evidence for HIV as the cause of AIDS is "clear-cut, exhaustive and unambiguous, meeting the highest standards of science."

It was widely hoped that Mbeki would use his keynote address at the conference opening to defuse the issue, but he did not. Instead, he said, some people "would consider the question I and the rest of our government have raised ... as akin to grave criminal and genocidal misconduct."

Mbeki said the real killer in Africa is extreme poverty, adding it seemed to him "that we could not blame everything on a single virus."

Wainberg, among others, called Mbeki's speech "bitterly disappointing." The fear is that Mbeki's position will distract from the fight against HIV.

New York researcher David Ho, a leader in the development of anti-HIV drugs, interrupted a dry lecture on the state of knowledge about the virus, to plead for Mbeki to change his position: "Mr. Mbeki," Ho said, "I beg you not to let your legacy be defined by inaction on this catastrophe."

But the conference closed on a different note, when former South African President Nelson Mandela -- explicitly linking HIV and AIDS -- called on both sides of the dispute to forget their differences and work together to battle the epidemic.

"For us, there is a need to be focused, to be strategic and to mobilize all of our resources and alliances and to sustain the effort until this war is won," he said. "We need -- and there is increasing evidence of -- African resolve to fight this war."

He also called on the rest of "this inter-dependent and globalized world" to join the fight.

The scientific side of the program had both good news and bad news.

On the negative side, a long-awaited study on the vaginal spermicide nonoxynol-9 showed it has no effect against HIV, and in fact may increase the risk of AIDS. The CDC's Gayle said the study was a disappointment, but added that many other such products are in development.

So-called vaginal microbicides -- which would kill HIV before it has a chance to enter the body -- are being sought because they can be used by women, unlike condoms, which require the consent of the male partner. In many parts of the world wearing a condom is regarded as unmanly, according to Peter Piot, executive director of the United Nations Joint Programme on HIV/AIDS (UNAIDS.)

As well, researchers reported that highly-active antiretroviral therapy (HAART) -- the drug cocktails that were hailed only four years ago as a possible cure for HIV infection -- is a long-term success in only about one-third of American patients.

Others are forced to change their drug regimes often, as the virus evolves resistance or they find the side-effects of the powerful drugs to be intolerable. Despite that, HAART continues to save lives where it is available, according to researchers from the Centers for Disease Control.

This conference was also the first time researchers admitted that the curative promise of HAART was an illusion: Tony Fauci, the head of the National Institute for Allergies and Infectious Diseases (NIAID), told a packed audience hall that, with our current drugs, "eradication is not possible."

He said the virus -- even when it is undetectable in the blood or lymph tissue -- "has an uncanny ability" to recover from attacks by drugs.

The debate over the curative power of HAART was overshadowed by the reality that the costly treatment -- $15,000 a year in North America -- is not widely available in the developing world and too expensive for most patients even where it is available.

But Fauci also suggested that a new therapeutic idea-called structured interrupted therapy -- might lower costs and make it easier for patients to follow the grueling drug regimes, which often require patients to take 40 pills a day.

In early data from NIAID tests on human subjects, Fauci said, interrupting therapy -- either one week on, one week off or two months on, one off -- appears to control the virus as well as constant treatment, while reducing the cost.

He said it's still too early to know whether there will be fewer side-effects, but the test subjects are excited about avoiding the "extraordinary burden" of the pill-intensive therapy.

The conference's scientific chairman, Salim Abdool Karim of the South African Medical Research Council, cited the structured interrupted therapy as one of the three most exciting scientific ideas to come out of the conference.

"It's still early days," he said, but the idea is intriguing.

The others, Karim said, were reports on interrupting mother-to-child transmission and data on new vaccine possibilities.

Data presented by researchers from the National Institutes of Health in Rockville, Md., showed that a short course of the drug nevirapine -- one dose to the mother during delivery and one to the newborn -- reduced the risk of passing HIV to the child by 30 per cent.

It has been known for years that another drug, AZT, also prevent mother-to-child transmission, but it took more doses and cost more. Karim said the data are still preliminary, but -- added to other research -- show that, "we've learned so much at this conference."

There was also, Karim said, "real excitement about vaccines." He said preliminary data on several new types of vaccines being tested in humans and in animals show real promise.

But the proof of the pudding, he said, will come in two years, when the 14th International AIDS Conference will be held in Spain: "In Barcelona," Karim said, "we will be looking for much more concrete results."

Officials said the Durban conference, which cost about $10 million to put on, will probably have a small surplus, which will be used for future meetings and for education programs in South Africa. It pumped about $27 million into the local economy, according to the Durban Chamber of Commerce and Industry.
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