Almost 4,000 individuals—basic scientists, clinical investigators, and global health researchers—gathered in Boston recently at the 12th Conference on Retroviruses and Opportunistic Infections to present, to discuss, and to critique their investigations into the epidemiology and biology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic. This conference, the most scientific of all of the HIV/AIDS conferences, included a keynote lecture and many plenary lectures that were highly scientific in nature. The venue also provided time for a discussion on the recent and much-publicized AIDS case in New York City.
Although information from bench scientists discussing new pathways of the virus and new drugs in very early stages of development was presented, the most prominent information came from the developing world. The opening plenary by Jim Yong Kim, MD, PhD, Director, Department of HIV/AIDS at the World Health Organization, highlighted the progress that the impressive “3 by 5” campaign has made. The World Health Organization has touted this program “3 by 5” as a global goal to provide three million people living with HIV/AIDS in developing countries with antiretroviral treatment by the end of 2005. Many countries are on target for this goal and many, most notably South Africa (one of the most developed countries in Africa), are critically behind their neighbors. Dr. Kim related that it is pessimism from the West and individual country bureaucracy that are the most powerful stumbling blocks in this initiative. He called on members of the audience to support the initiative and to understand the importance of their impact on the success of programs, if they have found themselves working with any of the start-up programs. He also demanded that nonphysician providers, nurses, must be trained and used to be a vital part of the stability of this program.
One area that has received much attention in the global treatment arena has been the use of single dose nevirapine (Viramune; Boehringer Ingelheim GmbH, Ingelheim, Germany) for the prevention of mother-to-child transmission (PMTCT). The drug has shown early viral resistance and drug side effects that are worrisome. Dr. James McIntyre, from South Africa, gave a very clear picture of this controversy. In the United States, women who are pregnant and HIV infected have access to state-of-the-art combination antiretroviral therapy. This drug has been shown to be a successful intervention to PMTCT. In countries where the seroprevalence rate is above 50% in antenatal clinics, measures need to be taken to improve care to improve the quality of life. In session 12, one abstract reported on a study using combination antiretroviral therapy for PMTCT and, until more research is completed showing the feasibility and efficacy of combination of antiretroviral therapy for reducing PMTCT, the single-dose intervention is the method of choice. However, what is most evident is including efforts to engage the family into care. Information from the PMTCT program, presented by Dr. Waafa El-Sadr from Columbia University, showed the importance and the intricacies of family-centered care.
On the policy front, Dr. Anthony Fauci, from the National Institutes of Health, outlined for the audience the road the United States government needs to take to support funding for research initiatives. He reviewed the government's call for streamlining initiatives to lessen duplication of efforts. He also gave a view into the challenges that are being faced in today's current political venue and the demands of the various problems that the world is facing.
A highlight of the conference was the special symposium about the recent AIDS case in New York City. The panel began with Dr. David Ho presenting the case. The individual was referred to Dr. Ho's research program at the Aaron Diamond Institute soon after the patient's diagnosis by his primary care physician. The individual has a significant history of multiple unprotected sexual encounters along with active use of methamphetamine. He had had previous HIV-negative tests up to 20 months before his illness. The virus with which he was infected showed multi-drug resistance in which only two medications—efavirenz (Sustiva; Bristol-Myers Squibb Pharma, Wilmington, DE) and enfuvirtide (Fuzeon; Roche Laboratories, Nutley, NJ; Trimeris, Inc., Durham, NC)—would show any efficacy. His AIDS-defining event was CD4 cell counts under 100 on several occasions. There were no follow-up data on the response to treatment at the time. Also on the panel was Dr. Stephen Gange from Johns Hopkins School of Public Health, who reviewed the two most extensive natural history cohorts—the National Institute of Allergy and Infectious Diseases Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS). Both of these studies included individuals who seroconverted during the time of the study. Both studies showed that there were individuals who were fast progressors, similar to the individual in New York. Others on the panel related that this does happen and that this new case was not one of a new strain but an occurrence that has happened before. Dr. Harold Jaffee, formerly from the Centers for Disease Control and Prevention, spoke about the public health aspect of the case. He noted that prevention among positives still needs to be encouraged. The activist community has been alarmed at this case and how the media has responded. Great efforts need to be taken so that an individual's human rights are protected in balance to the public's safety.
Also at the conference, hundreds of posters, by beginning and seasoned researchers, covered topics from macrophages to CCR5 receptors to toxicities, from resistance studies to studies that still show that the diagnosis of this infection is still being missed when the patient presents initially. Information from programs in the United States, Europe, and the developing world were widely represented. Posters and Web casts are available at www.retroconference.org. Log on to that Web site and find out the latest information to continue excellence in providing care.