Early Treatment Trial to Headline AIDS Conference

Marcia Frellick

July 14, 2015

Evidence presented at the 8th International AIDS Society (IAS) Conference could lead to a tipping point in how and when to treat HIV, according to conference cochair Julio Montaner, MD, director of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada.

"Everything that we hoped for in 1996, that we called for in 2006, will now be demanded, based on evidence that will come together at the conference," he told Medscape Medical News.

In 1996, scientists mobilized around triple therapy. In 2006, researchers developed the controversial strategy of seeking out and treating all people with HIV. This year, the evidence is there to put the ball back in the politicians' court to fully support the work to "end the epidemic in our lifetime," said Dr Montaner.

It is anticipated that at least 6000 participants from more than 125 countries will be in Vancouver to attend the conference.

At the meeting, full results will be presented from the Strategic Timing of Antiretroviral Therapy (START) trial, which was stopped early because the data showed that people with HIV have a much lower risk for AIDS and other serious illnesses if they start treatment early, Dr Montaner explained.

It is expected that results from the HPTN 052 trial will confirm whether, in people whose infections were suppressed with therapy, the dramatic decreases in sexual transmission were sustained over several years.

After the conference, we can turn to the political leadership of the world and tell them, 'You have nowhere to hide.' Dr Julio Montaner

The latest advances in adherence techniques for preexposure prophylaxis will be examined, as will sexual behavior and the incidence of HIV and sexually transmitted infections in populations such as men who have sex with men and transgender women in Brazil and the United States.

One session will involve a discussion of a perinatally HIV-infected adolescent who has shown unprecedented virologic remission many years after the discontinuation of antiretroviral therapy.

"After the conference, we can turn to the political leadership of the world and tell them, 'you have nowhere to hide.' You either want to stop the epidemic or you don't want to stop the epidemic," said Dr Montaner.

Advances have surpassed the goals for 2015. The next step is worldwide adoption of the UNAIDS 90/90/90 goal to end AIDS by 2020 by having 90% of people infected with HIV knowing their status, getting 90% of those diagnosed treated, and achieving viral suppression in 90% of those receiving treatment. "Treatment as Prevention" work by Dr Montaner's team has laid the groundwork for the 90/90/90 goal.

Honoring Crash Victims

On July 17, it will be 1 year since Malaysia Airlines flight MH17 was shot down over eastern Ukraine. Among the 298 casualties of that tragedy were six people on their way to the 20th International AIDS Conference in Melbourne, Australia.

A biennial 30-minute lecture series named after prominent AIDS researcher Joep Lange, MD, PhD, who was aboard that flight, begins this year with a tribute to his contributions to HIV, AIDS research and treatment, especially in settings with limited resources such as Africa and Asia.

His picture sits at the entrance to our center and in my office. Dr Julio Montaner

Dr Lange was a former president of the International AIDS Society and headed the Department of Global Health and the Amsterdam Institute for Global Health and Development.

Dr Montaner described Dr Lange as a close friend and an outstanding professional collaborator and said his loss "was a terrible personal and professional blow."

"I think of him frequently. His picture sits at the entrance to our center and in my office," he added. "While he is irreplaceable, and his many dreams and projects will never be the same, we are continuing the effort. I am sure he would be pleased by the progress we have seen in the last year alone, and would have been looking forward to celebrating in Vancouver. We will miss him privately and celebrate him publicly at the conference."

Also killed were Glenn Thomas, media relations coordinator for the World Health Organization in Geneva, Switzerland; Lucie van Mens, director of program development and support for the Female Health Company; Martine de Schutter, from the nonprofit Aids Fonds; and Pim de Kuijer, a writer, political activist, campaigner, and lobbyist for STOP AIDS NOW.

Cutting-Edge Strategies

During the plenary session, entitled "From Care to Cure," Nicolas Chomont, PhD, from the University of Montreal in Canada, will discuss advances in gene therapy to replace infected cells with noninfected ones, shock-and-kill strategies to reactivate the virus in these cells and then eliminate them, and immunologic strategies that might reduce the reservoir and increase the immune functions of patients with HIV who are receiving antiretroviral therapy.

There has been a rapid increase in the understanding of how HIV persists. However, "a better characterization of the virologic and immunologic mechanisms that need to be targeted to interfere with HIV persistence is needed. Novel potential eradication strategies that can be safely and rapidly translated into clinical trials should be prioritized," he told Medscape Medical News. And an affordable and scalable cure for all remains a formidable challenge.

In another plenary session, Eric Hunter, PhD, from the Emory Vaccine Center in Atlanta, Georgia, will look at whether unique biological traits characterizing transmitted viruses can be identified that might be useful to target with vaccines or microbicides.

"We have come a long way in understanding key features of transmission. Nevertheless, our newly established ability to generate infectious molecular clones of viruses from both the transmitting and newly infected partner of transmission pairs, coupled with additional studies under conditions that better mimic genital tissues during transmission, will shed additional light on potential targetable traits of the transmitted virus," he told Medscape Medical News.

Dr Montaner, Dr Chomont, and Dr Hunter have disclosed no relevant financial relationships.


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