AIDS 2012

Renewed optimism

AIDS 2012 – the largest gathering of the global AIDS community – concluded its biennial meeting in Washington, D.C on 27 July with a clear sense that the end of the AIDS epidemic is possible with sustained financial, political and scientific commitment. Middle East Health reports.

The theme of this year’s weeklong AIDS 2012 conference was ‘Turning the Tide Together’ which resonated with delegates as they left the conference with the understanding that though a vaccine or cure is still necessary, scaling up resources and the tools available now has the potential to save millions of lives. For the first time in the history of these conferences delegates came away with optimism that this devastating epidemic can finally be beaten.

“AIDS 2012 has brought delegates together from around the world to Washington, D.C. – with one aim in mind – to turn the tide on the HIV epidemic. We have seen breaking science, exciting strategizing for a cure, sessions for the young and old affected by HIV, to name just a few.

“The success of the Global Village and the Youth Programme has galvanized the efforts of the activists and young scientists who will be the future of our fight to end AIDS,” said Dr Elly Katabira, AIDS 2012 International Chair, President of the International AIDS Society (IAS) and Professor of Medicine at Makerere University in Kampala, Uganda. “As International Chair, I would like to commend everyone for their tireless efforts to make AIDS 2012 a truly great conference, and I urge delegates to maintain the momentum.”

AIDS 2012 drew nearly 24,000 participants from 183 countries. The programme featured 194 sessions covering science, community and leadership.

“AIDS 2012 represented many milestones in the history of the International AIDS Conference, but most importantly, it is the first time we have been united around the one goal to end AIDS,” said Dr Diane Havlir, AIDS 2012 U.S. Co-Chair and Professor of Medicine at the University of California, San Francisco. “Serious dialogue is now happening about collaboration among the diverse communities involved in this effort – science, advocacy, faith, and vulnerable populations. In the face of all of this optimism, I am humbled by the job ahead of us, but this meeting has inspired me. I know we will keep moving toward our shared goal of ending AIDS.” Thousands of delegates signed the Washington, D.C. Declaration, the official declaration of the XIX International AIDS Conference. The declaration states that we must strive for multidisciplinary approaches that respect and uphold the human rights and dignity of all people affected by the epidemic and calls for nine concrete actions.

Sign the Washington DC Declaration

Incoming IAS President and AIDS 2014 International Conference Chair Prof. Françoise Barré- Sinoussi gave an inaugural address. Barré-Sinoussi, a Nobel Laureate, is Director of the Regulation of Retroviral Infections Unit at the Institute Pasteur in Paris.

At the conclusion of the Closing Session, Katabira, Havlir and Barré-Sinoussi officially transferred the International AIDS Conference globe from Washington, D.C., to Melbourne, Australia, which will host the XX International AIDS Conference in July 2014. Accepting the globe for Melbourne were AIDS 2014 Australia Chair Sharon Lewin, Professor of Medicine at Monash University, and representatives of the AIDS 2014 local partners.

Renewed optimism in the search for a cure

It is estimated that for every person starting treatment, two are newly infected, a path that is clearly unsustainable.

Given these limitations, there is growing recognition that the search for an HIV Cure is an imperative both in terms of the individual and public health benefits it would provide and also an opportunity to potentially avoid the long-term cumulative costs of ART.

Also, an effective and scalable HIV cure will likely achieve what preventative approaches aim to do, which is to essentially stop transmission of HIV to those who are uninfected and restore the immunological function and normal health to those who are infected.

The renewed optimism in the search for an HIV Cure amongst scientists is based on a number of scientific advances that are helping to shed light on why it is that HIV remains persistent.

Scientists have known for some time now that latent HIV reservoirs, where HIV hides and persists, are one of the main barriers to finding a cure. This is precisely why treatment does not eradicate HIV and why, when treatment is stopped, the virus rebounds.

“What we haven’t had until very recently is clear insights into why HIV persists during therapy,” said Steven Deeks, at the AIDS 2012. “Our basic understanding of the mechanisms of HIV persistence in latent reservoirs is far superior than it was a decade ago. We are entering a stage in the epidemic in which we can seriously begin testing drugs that either prevent latency or which force the virus out of its hiding place, make it susceptible to our current drugs.”

Several recent observations make scientists enthusiastic about pursuing cure research.

For the first time ever there is now a “proof of concept” for an effective cure. The case of Timothy Brown, the so-called “Berlin Patient”, who received a stem-cell bonemarrow transplant in 2007 and is now considered to be cured of HIV, has proved that a cure is at least possible. This stem cell transplant worked because the donor was among the 1% of Northern Europeans who lack CCR5, the “doorway” through which HIV enters cells. While it is unrealistic to pursue this risky and costly therapeutic approach for most people, it has nevertheless got scientists thinking about the use of gene therapy to modify a patient’s own immune cells to make them resistant to HIV infection.

The molecular biology regarding how HIV DNA becomes integrated in the chromosomes of infected people is the focus of intense research. This work has already led to a number of possible interventions, some of which are being tested in the clinic. Recently, in a test in HIV+ patients, David Margolis and colleagues showed that a dose of a drug that inhibits an enzyme involved in HIV silencing leads to rapid production of HIV RNA in the patient’s latently infected cells. This could make such previously unreachable viral reservoirs susceptible to curative strategies. For example, in combination with treatments that enhance host immune defense, unmasking latent virus might allow clearance of infection.

Scientists have also been aware of a rare group of HIV infected people who appear to have naturally “cured” their own infection. These “elite controllers” are HIV positive but have no readily apparent virus in the blood. Scientists are gaining a better understanding of this group of patients.

Call to deal with key affected populations as public health concerns, not as criminals

At a time when the potential of new HIV prevention technologies and treatment as prevention to turn the tide of the HIV/AIDS epidemic is greater than at any other time in the past three decades, experts are calling for a sweeping reassessment at all levels of decision making to turn around the disproportionately high rates of HIV prevalence in those groups most vulnerable to infection, delegates heard at the XIX International AIDS Conference (AIDS 2012) taking place in Washington, D.C.

Men who have sex with men (MSM), injecting drug users (IDUs), transgender people and sex workers continue to experience denial, stigma, prejudice, discrimination and tokenism that have led to both a resurgence and exacerbation of HIV epidemics in those populations in parts of the globe.

“If we are to take advantage of the huge possibilities that the science is now affording us in tackling the epidemic, we urgently need the most vulnerable populations at the table, but at the same time we need governments to be brought to account for policies that are criminalizing sexual preference and people´s behaviours rather than dealing with these issue as public health concerns;” said Dr Elly Katabira, AIDS 2012 International Chair and President of the International AIDS Society (IAS).

“However, we also need to do better at our end. Outreach programmes to these vulnerable groups need to be scaled up, to be made more effective and to more adequately reflect the demographic of local epidemics and not placed in the too-hard basket.”

“We´ve seen over three decades that evidence-based approaches to public health have been the most effective instruments in driving down new infection in high-risk groups,“ said Dr Diane Havlir, AIDS 2012 U.S. Co-Chair and Professor of Medicine at the University of California, San Francisco. “Needle exchange programmes have saved millions of lives in many countries the world over, legal reform of sex work in some countries has reduced exposure to infection and the decriminalization of homosexuality is strongly linked to effective outreach in that community.”

Speaking at a plenary session at the conference, Dr Paul Semugoma, physician, The Global Forum on MSM & HIV, Uganda, said: “At 30 years, the HIV pandemic is not young. Neither is it a new concept that men who have sex with men (MSM) and transgender people are particularly vulnerable to infection. What is new are the tremendous prevention and care options; exciting possibilities for curbing the ravages of HIV, in the world and in Africa. It is thus particularly challenging that we are stumbling on the same old blocks of denial, stigma, prejudice and discrimination.”



Study shows AIDS patients should be treated early with ARVs

A new study has been released at the XIX International AIDS Conference confirms that patients treated early and then taken off antiretroviral therapy have shown no signs of a resurgence of their HIV infection.

There exists a unique cohort of patients in France who became HIV infected, started therapy early, and were able to successfully stop therapy without having a resurgence of their HIV infection (the “Visconti Cohort”). The study confirms the benefits of treating HIV at the very early stages of infection.

“These results suggest that the antiretroviral treatment should be started very early after infection, said Charline Bacchus, lead researcher of the study at the French National Agency for Research on AIDS and Viral Hepatitis.

There is an immensely valuable store of knowledge to be gained from analysing the immunological characteristics that made therapy redundant for these patients and the VISCONTI group of patients is one of the key scientific reasons behind the renewed optimism in the search for an HIV Cure.


New funds for vaccine research

It was announced early July that new consortium Duke University of Durham, North Carolina and the Scripps Research Institute of La Jolla, California in the US have been awarded US$31 million in firstyear funding to lead the new Centers for HIV/AIDS Vaccine Immunology & Immunogen Discovery (CHAVI-ID). The funding is from the US National Institute of Allergy and Infectious Diseases, part of the US National Institutes of Health.

The initiative is projected to receive up to $186 million or more over the next six years. The goal is to accelerate HIV vaccine development by supporting multidisciplinary research into immune responses that prevent or contain HIV infection and generating model vaccine components that can induce these protective immune responses.

CHAVI-ID, a consortium of researchers at universities and academic medical centres, will build on advances made in several laboratories, including the Center for HIV/AIDS Vaccine Immunology (CHAVI), based at Duke University. CHAVI's seven-year funding award from NIAID ended in June.


 Date of upload: 26th Sep 2012


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