Neil Canavan

June 21, 2013

KUALA LUMPUR, Malaysia — The highly anticipated HIV treatment guidelines from the World Health Organization will be released next week at the 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention.

Investigators will also discuss recent headline-grabbing cases suggesting a potential cure for HIV. Researchers will present data on the success of treatment-as-prevention strategies. And delegates will learn more about effective management of long-term survivor comorbidities.

Dr. Chris Beyrer

"We happen to have very good timing this year, in that several important trials in the HIV field have ended recently, so a number of early reports of those trials will be presented in Kuala Lumpur," IAS president-elect Chris Beyrer, MD, told Medscape Medical News.

The first is Project Accept (HPTN 043), a randomized controlled trial looking at mobile HIV testing in sub-Saharan Africa and Thailand (abstract TUSS01). Investigators compared clinic-based HIV testing and counseling with community mobile care with a strong community engagement. "They had a really remarkable impact on recruiting men, particularly in sub-Saharan Africa," Dr. Beyrer said. "It turns out that if we set up testing in ways that are convenient to working men — so that they don't have to take time off from work — you really can get great levels of acceptance."

The other newly completed project, by the HIV Vaccine Trials Network (HVTN 505), had far less encouraging results. The trial was halted and prompted the creation of a special session at IAS 2013.

HIV Vaccine Trial Halted

"The full results of the trial and the immunologic outcomes are going to be presented at the next AIDS vaccine conference," Dr. Beyrer said, "but we felt that this was so important that we set up a separate session to review the state of the HIV vaccine research effort in light of HVTN 505 and other trial results."

The Bangkok Metropolitan Authority, in conjunction with the Centers for Disease Control and Prevention (CDC), will report outcomes from a phase 3 trial of tenofovir pre-exposure prophylaxis for HIV prevention in Thai injection-drug users (abstract WELBC05). Results from that study were recently published in the Lancet, and the CDC updated their guidelines to reflect the findings.

This is the first trial evaluating this approach in populations with injection risks, and will be the subject of a late-breaker presentation at the meeting, Dr. Beyrer pointed out. "This is really important globally, but is particularly relevant in the Asian Pacific because there are a number of countries in the region with substantial epidemics of HIV in injection-drug users."

This conference, organized in partnership with the Center of Excellence for Research in AIDS (CERiA), is the world's largest open scientific conference of its kind. It is anticipated that IAS 2013 will attract more than 5000 scientists, clinicians, public health experts, and community leaders from around the world.

Dr. Adeeba Kamarulzaman

"Having the conference here in Asia allows us to put the spotlight on a region that continues to see a continually growing epidemic," Adeeba Kamarulzaman, MD, meeting cochair and director of CERiA, told Medscape Medical News. "Asia, given its sheer size and population, has a large burden of people living with HIV — close to 5 million. The pattern of infection is diverse from country to country but, in general, most countries are experiencing concentrated epidemics among key affected populations."

A special HIV/HCV symposium, entitled Is Your Patient Being Left Behind? New Options and Unmet Needs, features a panel of experts that will focus on the difficulties of treating coinfected patients. Speakers will review therapeutic options for those with nongenotype 1 infection, evaluate management strategies for nonresponders and relapsers, and discuss the availability of new interferon-free strategies (abstracts TUBS0202, TUBS0203, TUBS0204, TUBS0205, TUBS0206).

Must See

Dr. Kamarulzaman said she has some personal must-see sessions to attend. The first of these will be the opening day's plenary session, entitled Achieving Universal Access and Moving Towards Elimination of New HIV Infections in Cambodia. "I am really looking forward to hearing Dr. Mean Chi Vun's presentation on the success in scaling-up treatment access in Cambodia," she said.

Also on her list is Daniel Douek's National Institutes of Health presentation on the relation between HIV and inflammation and the increasing comorbidities of long-term AIDS survivors (abstract TUPL0102). And because "stigma represents one of the biggest stumbling blocks to implementing many of the prevention and treatment programs that have proven to be effective," Dr. Kamarulzaman is planning to attend Dr. Aziza Ahmed's presentation on HIV, the law, and stigma (abstract MOPL0105).

I think this is going to be a really eye-opening talk.

Dr. Beyrer also has a must-see list. "I'm really looking forward to Linda-Gail Bekker's plenary talk, entitled Pediatrics: The Transition from Adolescence to Adulthood," he said (abstract WESY01). "We have a terrible truth in this business: We've ignored adolescents in the interest of what I think is a very misguided approach to trying to protect them. We have let the issue of consent and ethical approval and all the rest of it have such a negative impact on these kids."

Dr. Beyrer said a much greater emphasis is needed to address the needs of young people 10 to 20 years of age, many of whom were infected perinatally, in negotiating the onset of sexual life. "I think this is going to be a really eye-opening talk."

His other must-see is all-encompassing. Conference organizers have brought in a team to help monitor back-to-back sessions. "After attending every session of every track, rapporteur teams will report highlights to a coordinator who will present summary findings on the last day of the meeting," Dr. Beyrer explained.

"I find that the summaries on the last day are incredibly helpful to get a sense of everything that just happened," he said.

The 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention. June 30 to July 3, 2013.


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