AIDSWEEKLY Plus, 8 July 1996
Daniel J. DeNoon, Senior Editor

The good news: HIV is on the run. The bad news: the AIDS pandemic is growing rapidly.

The highlight of the XI International Conference on AIDS, to be held July 7-12, 1996, in Vancouver, Canada, will be the presentation of clinical trial results showing that the most potent of the new HIV protease inhibitors - when combined with zidovudine (AZT) and lamivudine (3TC) - can control HIV infection.

Tantalizing data from small but growing numbers of subjects suggest that as long as people with HIV infection can continue taking the three-drug combination, they can remain free of AIDS symptoms.

But for the 80 percent of people with HIV infection who live in developing nations (and for many in the developed world) this treatment will be far too expensive.

An HIV vaccine is currently the best hope for those without access to expensive drugs. HIV vaccine trials and development strategies will therefore be a major concern of the 1996 Vancouver AIDS conference - particularly in light of data that will show the AIDS epidemic to be increasing rapidly in Asia and in Africa.

Only two years ago headlines from thexInternational Conference on AIDS in Yokohama, Japan, trumpeted the gloomy news that none of the anti-HIV treatments under development appeared to be making much headway. Protease inhibitors in particular appeared to be doomed: most of them were extensively bound by serum proteins, and HIV could easily develop resistance to all of them.

But subsequent studies showed that optimal dosing and combination can overcome these problems. Studies at the 1996 Vancouver AIDS conference will show that the protease inhibitor/AZT/3TC combination can reduce HIV to undetectable levels for more than two years - and probably much longer.

Ironically, the key to the rapid development of protease inhibitors was first announced at the 1994 Yokohama AIDS conference: the successful development of tests that could measure the amount of HIV RNA in plasma. These tests for the first time permitted drug developers and clinicians to directly measure a patient's viral burden, permitting rapid assessment of drug efficacy.

A major drawback to these tests is that they can detect HIV RNA levels only as low as 200 copies per milliliter of plasma. Thus patients with undetectable levels of HIV could in reality have more than a million infectious virions in circulation. Tests at least 10 times more sensitive are needed; reports on progress in this area will be hot conference topics.

Perhaps with an eye to the implications of disparities in access to AIDS therapies, the theme of the Vancouver conference is "One World One Hope."

The conference co-chairs are Martin T. Schechter and Michael L. Rekart; program co-chairs are Michael V. O'Shaughnessy and Julio S.G. Montaner.

The four co-chairs have issued a statement in which they laid out four "Guiding Principles" for the eleventh international AIDS conference:

* Excellence. "The rigorous abstract review process provided the means to ensure the research and programs presented are the best the world has to offer," Schechter et al. wrote.

* Practicality. This theme led to two developments: incorporation into the program of skills-building workshops for transfer of practical expertise, and a scholarship program to offer conference scholarships "to as many of our 2,000 applicants as possible."

* Sustainability. "The reduction in AIDS research funds and the diminishing commitments of some governments have reached crisis proportions," Schechter et al. wrote. "Our collective efforts to sustain the sense of urgency needed to mobilize governments, the private sector, the media, and the general public may mean the difference between our success and failure in overcoming HIV/AIDS."

* Solidarity. In the beginning, the organizers observed, by solidarity they referred to their goal of maintaining cooperation between scientists, AIDS activists, community workers, caregivers, and policy makers. But they now feel that they must address larger health-research issues. "We categorically reject political strategies which attempt to create competition between people suffering from different diseases," they wrote. "Rather, we accept the notion that every dollar not wasted on war and weapons of mass destruction is a dollar more for health. To us and to many others, the importance of solidarity refers to the need for all people to demand that health care and health research remain priorities within our societies."

The conference's oral presentations will be divided into morning plenary sessions and afternoon concurrent abstract sessions.

Poster sessions will be augmented by two innovations:

* Poster symposia will be formal, moderated discussions dealing with six posters on a single, specialized topic.

* Poster discussions will be smaller, less formal moderated discussions also dealing with six posters on a single, specialized topic.

As usual, topics will be grouped into four tracks:

* Track A: Basic Science. Includes laboratory research topics such as virology, microbiology, and immunology.

* Track B: Clinical Science. Includes both clinical- research and clinical-care topics. Announcements of clinical trial results are usually the most intensely followed portions of the conference program.

* Track C: Epidemiology and Public Health. Includes discussions of HIV incidence, prevalence, natural history, and prevention.

* Track D: Social Science: Research, Policy, and Action. This track addresses the social impact of HIV disease and the responses of individuals, communities, governments, and cultures to the epidemic.

An innovation of the Vancouver conference is the organization of three "pathways" linking related sessions across various tracks. There are three of these pathways:

* Women and HIV. Although women are equally represented in the worldwide AIDS epidemic, most research has focused on men. This pathway identifies research topics focusing on women with, and at risk of, HIV infection.

* Development and HIV. This pathway identifies research on the impact of HIV/AIDS on developing countries and newly independent states.

* Living with HIV. This pathway will identify presentations of particular interest to people with HIV and to community- based organizations.

Another innovation is the Distinguished Lecturer Series in which AIDS research "mentors" will speak on whatever is on their minds. Lecturers scheduled to date are, in order of presentation:

Basic Science: Robert Gallo, William Paul, and Luc Montagnier.

Clinical Science: Anthony Fauci, Jay Levy, and Paul Volberding.

Epidemiology and Public Health: James Curran, Margaret Fischl, and Catherine Peckham.

Social Science: Jonathan Mann, Maggie Atkinson, and Jane Galvao.

Plenary sessions will be held on each of the four full days of the conference. The titles and presenters of these major addresses are:

* Advances in Antiretroviral Therapy and Viral Load Monitoring. Scott M. Hammer, Deaconess Hospital, U.S.

* HIV Genetic Diversity. Francine E. McCutchan, Walter Reed Army Institute of Research, U.S.

* The Epidemic of HIV among Young Gay Men. John B.F. de Wit, University of Utrecht, Netherlands.

* Empowerment, Community Mobilization, and Social Change in the Face of HIV/AIDS. Richard Parker, Associacao Brasileira

Interdisciplinar de AIDS (ABIA), Brazil.

* Perinatal Transmission: Associated Factors and Therapeutic Approaches. Yvonne Bryson, University of California, U.S. * Female-Controlled Methods to Prevent Sexual Transmission of HIV. Christopher Elias, The Population Council, U.S.

* Molecular Biology and Drug Development. Didier Trono, The Salk Institute for Biological Studies, U.S.

* Continuum of Care in Resource-Poor Settings. Connie M. Osborne, University Teaching Hospital, Zambia.

* HIV and Development. Josef Decosas, Canada.

* Positive Developments in Interventions. Georgette Adjorlolo, Projet RETRO-CI, Ivory Coast.

* The Impact of HIV on Families and Children. Katherine Nyirenda, Minbank Medical Services, Zambia.

* HIV Viral Dynamics. John M. Coffin, Tufts University, U.S. Yet another innovation at the Vancouver conference will be a series of debates following the plenary addresses. These debates focus on four controversial topics in AIDS research and AIDS policy implementation. The topics and debaters are:

* Drug Policy: Resolved that the prohibition of addictive drugs can make a significant contribution to HIV prevention and control. Affirmative: Ann Britt Grunewald, Osteraker National Prison, Sweden. Negative: Ernest Drucker, Montefiore Medical Center, U.S.

* HIV Vaccines: Resolved that more fundamental research in vaccine development is required prior to the implementation of Phase III trials of HIV vaccines. Affirmative: John P. Moore, Aaron Diamond AIDS Research Center, U.S. Negative: Edward K. Mbidde, Uganda Cancer Institute, Uganda.

* HIV Counselling and Testing: Resolved that government/public resources for HIV prevention in the developing world should not be directed toward the provision of HIV counselling and testing services. Affirmative: Jon Ungphakorn, ACCESS, Thailand. Negative: Mary Grace Alwano- Edyegu, AIDS Information Center, Uganda.

* Pathogenesis: Resolved that viral factors, and not host factors, are the primary determinants of pathogenesis. Affirmative: David D. Ho, Aaron Diamond AIDS Research Center, U.S. Negative: Giuseppe Pantaleo, National Institute of Allergy and Infectious Diseases, U.S.

The conference will conclude with rapporteur sessions. These sessions feature experts who will summarize conference presentations in the four basic tracks:

* Basic Science: Deborah L. Birx, Walter Reed Army Institute of Research, U.S.

* Clinical Science: Kevin M. De Cock, London School of Hygiene and Tropical Medicine, U.K.

* Epidemiology and Public Health: Roel A. Coutinho, Municipal Health Service, Netherlands.

* Social Science: Purnima Mane, Joint United Nations Program on HIV/AIDS, India.

An unusually large number of satellite conferences orbit this year's AIDS conference. The following conferences are sponsored by commercial organizations:

* Janssen-Cilag. "Opportunistic fungal Infections in HIV/AIDS: Emerging Challenges and a New Solution."

* Merck Sharp & Dohme. "Protease Inhibitors: Treatment Strategies."

* Hoffmann-La Roche Ltd. "Changing Care: Evidence-Based Decisions in HIV and CMV Therapy."

* Glaxo Wellcome and BioChem Pharma. "Turning the Tide against HIV: Recent Advances in Combination Antiretroviral Therapy.

* Agouron Pharmaceuticals. "Recent Advances in Combination Antiretroviral Therapy."

* Gilead Sciences. "Management of CMV Retinitis: Where Are We Today?"

* Ortho Biotech. "HIV Infection and AIDS: New Biology, Therapeutic Advances, Clinical Implications."

* NeXstar. "Update on AIDS-Related Liposomal Therapy in the Clinic."

* Bristol-Myers Squibb Co. "Improving Survival in People Living with HIV Infection: Current Therapies, Future Strategies."

* Serono Laboratories Inc. "State-of-the-Art Approach to AIDS Wasting."

* Direct Access Diagnostics. "HIV and Telemedicine: Increased Access to High Quality Testing and Counselling Services through Technology."

* Pfizer. "The Immunocompromised State and Opportunistic Infections."

* Boehringer Ingelheim and Roxane Laboratories. "Non- Nucleoside Reverse Transcriptase Inhibitors, The New Class of Antiretrovirals."

* Glaxo Wellcome USA. "Co-Conspirators: Opportunistic Infections in HIV."

* Abbott. "Emergence of a New Approach in HIV Disease Management."

* Bio Technology General Corp. "The Weight Loss Dilemma: The Role of Anabolic Steroids."

The following conferences are sponsored by governmental organizations:

* National Institute of Mental Health. "Role of Families in Preventing and Adapting to HIV/AIDS."

* U.S. Centers for Disease Control and Prevention (CDC), Health Canada, U.S. National Institutes of Health, The Joint United Nations Program on HIV/AIDS, and Canadian Public Health Association. "HIV Prevention Works."

* European Commission. "The European Communities' HIV/AIDS Program for Developing Countries Directorate-General for Development (DG VIII)."

* World Health Organization. "STD/HIV Interactions."

* European Commission. "The Europe Against AIDS Program of the European Commission - DGV."

* National AETC Program, United States Department of Health and Human Services; Health Canada (under the National AIDS Strategy). "Trinational Satellite Symposium: Innovative Partnerships in Education and Care between Health Professionals and People Living with HIV."

* Sexually Transmitted Diseases Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health. "Topical Microbicides."

* Sexually Transmitted Diseases Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health. "Treatment of Sexually Transmitted Diseases to Prevent HIV Infection."

There will also be 34 satellite conferences sponsored by non-profit organizations.

960708
AW960704

Copyright © 1996 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA.