HIV ALIVE - AIDS Conference EXTRA - August 8, 2008

We won't just survive; we'll thrive - as we eradicate the virus.

World leaders joined 25,000 attendees of the XVII International AIDS Conference, which began Sunday August 3, 2008 and ends today in Mexico City. Prominent speakers included Secretary General of the United Nations Ban Ki-Moon, and Mexican President Felipe Calderon Hinojosa.

Former American President Bill Clinton gave the keynote address. "AIDS is a very big dragon. The mythological dragon was slain by Saint George, the original knight in shining armor, but this dragon must be slain by millions and millions of foot soldiers," Clinton told the gathered activists.

Health professionals included Margaret Chan, MD Director General of the World Health Organization, Pedro Cahn, MD, President of the International AIDS Society, and Peter Schick of The Peter Schick Foundation

"Universal action now," was the theme of the conference. The resources to fight HIV are at now an all time high, thanks increased help from the Bill and Melinda Gates Foundation, the Global Fund, and the President's Plan for Emergency AIDS Relief, PEPFAR, which was signed into law by President George W. Bush on July 30th. Still, new infections keep outpacing the number of people beginning first time treatment.

AIDS has already killed 30 million people. 2.7 million people were newly infected with HIV / AIDS last year, a disease that is entirely preventable. The Global HIV Prevention Working Group claimed that many of these infections occurred because governments are ignoring solid science showing that changing behavior works. The most effective behavior modifications include engaging in safer sex by delaying the onset of intercourse, using condoms, and circumcising males. Intravenous drug users should cut back while needle exchange programs should increase. . Myron Cohen, MD of the University of North Carolina stressed that we can not treat our way out of the epidemic. Prevention and treatment efforts "need to get married today."

The conference didn't shy from contentious issues. One session bluntly asked in this overwhelmingly Catholic country if religion were a barrier to HIV prevention. Another looked at changing gender norms for girls and women Other discussions explored the unique problems of Black Americans dealing with AIDS and the role of prisons and detention centers in propagating the disease. One defined the continued travel ban on HIV+ patients by a dozen of the world's countries, as a human rights issue.

Finally the conference did a bit of prognostication, looking at where the epidemic would be in 2031.

For anybody coping with HIV, a number of promising avenues of new research were brought to view, which will be highlighting in this and future issues of HIV Alive. As Peter Schick put it, "The Mexican conference is gigantic. It will take a long time to catch up with the thousands of treatment abstracts presented."

With vaccine and microbicide trials yet to show promise, researchers are now focusing on pharmaceutical prophylaxis as a way to fight AIDS, according to a report issued by the AIDS Vaccine Advocacy Coalition. The use of antiretroviral drugs for infection prevention, called PrEP, comes out of the success such efforts have had in cutting transmission rates of HIV to fetuses from infected mothers. In 2007, Family Health International studied the antiretroviral drug tenofovir as away of preventing HIV infection in Ghanan women. Although the study showed that the drug was safe and tolerated in uninfected users, it did not produce definitive proof of its effectiveness in preventing the spread of HIV. By 2009 15,000 people are expected to partake in the new PrEP studies worldwide.

Results of the studies would ultimately be hard to interpret, because participants in this unproven method would be more likely than others to engage in lower risk behavior. Since typical anti-viral cocktails for HIV positive patients run more than $20,000 a year, cost becomes an issue. How much preventive pharmeceutical intervention to prevent HIVis justified? If pharmaceutical prophylaxis catches on, just in the ares of foreign funding, AIDS costs to the US taxpayer are projected to climb from $2 billion a year today to $12 billion in just eight years. Some candidates for daily pills question whether simply taking doses before sex would be as effective in preventing infection with HIV. If the virus dismebarks into a hazardous environment it might be killed quickly and cleanly.

According to activists, like Laurie Garrett, a senior health fellow at the Council on Foreign Relations, daily pharmaceutical prophylaxis is the wrong way to fight AIDS because the initiative's true aim is to create a multibillion dollar AIDS treatment industry with a vested interested in maintaining the status quo. She says that medicine’s ultimate goal should be the eradication of the virus.

Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases, NIAID, told the conference that the only way to stop HIV pandemic is through biomedical research.  Despite medicine’s success in managing HIV, nobody has been cured yet. “This is because HIV is unlike virtually any other virus in its ability to hide from the immune system in protected cellular sanctuaries that we call ‘latent reservoirs.’… Our best hope for eradicating HIV from the reservoirs may be to diagnose and treat people aggressively very early in infection, before the reservoirs have become too large.” Fauci stressed that such early treatment might not totally eradicate the virus, but by keeping the reservoirs low, allow the immune system to better handle infection so a patient could ultimately come off anti-viral therapy. He described this as a "functional cure." This approach is at the heart of The Peter Schick Foundation's early treatment protocols. Despite recent setbacks, Dr. Fauci also held out hope for a vaccine.

- Edited by Paul M. J. Suchecki

President Bill Clinton
© International AIDS Society / Mondaphoto