Our conference coverage in this issue comes from a meeting on HIV and women’s health, another on HIV persistence and cure research, as well as the European AIDS Conference and ICAAC.

The possibility that the slow momentum from numerous research groups pursuing a cure for HIV is an exciting one and Richard Jefferys both summarises the state-of-the-art in this field and comments on the complexities of interpreting these early results in his report from the persistence workshop.

This issue also highlights serious concerns for treatment access and global health including changes at the Global Fund and responses to the suspension of round 11 grants – that became likely last year when donor pledges failed to meet even the minimum budget.

TB reports include the shocking state of TB in South African prisons, covered by Nathan Geffen who also reports encouraging results from the ZAMSTAR study and more news on two promising MDR TB drugs.

We also include summaries of journal articles, focusing on pregnancy and paediatrics, a summary of the new drug resistant TB guidelines and report the stopping of the oral tenofovir arm of VOICE PrEP study.

May we take this opportunity to wish you a happy new year and happy reading.

We conclude our reports form the BHIVA and CROI meetings this year and include exciting news on treatment access due to Gilead entering an agreement with the Medicines Patent Pool.

New recently approved drugs (in the USA) include the new NNRTI rilpivirine and a new triple drug fixed-dose combination of rilpivirine/tenofovir/FTC.

We also launched the i-Base/TAG 2011 pipeline report in Rome as a supplement to HTB that updates the pipeline development of all important drugs, diagnostics and treatment strategies for HIV, hepatitis and TB.

We include reports from the 18th Conference on Retroviruses and Opportunistic Infections (CROI). This annual meeting showcases some of the most important new developments in HIV research each year.

In this issue we report successful early findings with immune -based treatment; better news with oral PrEP and topical gels and some important studies in focusing on pregnancy.

We also include some new drug approvals and label and guidance changes.

It is interesting to note that even a richly resourced setting like that provided for by the London Consortium in the UK, managing the HIV budget within the NHS has led to a recommendation that new patients start with abacavir instead of tenofovir.

Nearer to home, we include MSF data from Lesotho showing tenofovir to be associated with fewer side-effect related switches compared to AZT or d4T in first-line treatment. These data will also help to allay a concern that renal toxicity rates from tenofovir might be unmanageably high in an African setting.

And in contrast to the more optimistic prevention studies reported at CROI, the FEM-PrEP study (conducted at sites in Africa) was stopped by the trials Independent Data Monitoring Committee (IDMC) due to an interim analysis that showed no difference between rates of new HIV infections in the active tenofovir/FTC (Truvada) group compared to the people using placebo. Which is disappointing news.

Our next issue of HTB South will be also be rich with conference reports, including from the 5th Southern African AIDS Conference in Durban, where you might have received this one.

Happy reading!

Conference reports also include exciting news on a new TB medication and diagnostic test (from the 41st Union World Conference on Lung Health); early data, presented at Glasgow, suggesting boosted PI monotherapy maintenance may not be a viable option in settings without access to viral load monitoring and promising results from the Caprisa 004 microbicide trial.

We also include a report from the iPrEX study and a summary of US CDC preliminary guidance for use of PrEP.

Richard Jeffery’s basic science reports include the published results from the single case of functional cure in an HIV-positive man who received stem-cell transplantation from a donor with the delta-32 deletion.

As usual, we don’t have room for all of our reports here, further conference reports and other news from HTB can be found on our website.

Happy reading!

The results are particularly important given that many treatment programmes in developing countries are under increasing pressure to limit enrollment of new patients, while 70% of people in immediate need of ARVs globally have yet to access them.

When treatment is pitched against prevention for funding, the phase ‘we can’t treat our way out of the epidemic’ is often used, and CROI provided new data challenges this misconception.

Another prominent statement is that ‘for every person put on treatment, there are two new infections’.

The CROI data challenges this too, though it has always been flawed logic to link these two unconnected figures.

The numbers accessing treatment are driven by the effectiveness of treatment programmes. Double the programme and the equation equalises. Scale treatment up four times and the impact is reversed: ‘for every two people on treatment only one person becomes infected’ etc.

When this connection is made it is insidious, because it implies that people on treatment are driving new infections. It is challenging and undermining our right to care. It seeks to connect two broadly different groups of people. New infections are predominantly driven by people who themselves are recently infected but currently unaware of their new HIV status, whereas people on treatment are likely to already have modified risks for onward transmission.

So, post-CROI, based on very conservations data from the PARTNERS and other studies, lets revise the link between treatment and prevention and say clearly that ‘every person on treatment prevents at least nine new infections’.

We welcome that the WHO guidelines now recommend treatment at 350 cells/mm3 and that they place a strong emphasis on using alternative nucleosides to d4T. That they place a high value on maternal health and they can now recommend breastfeeding with antiretroviral interventions are also good news.

Our next issue will include further reports from CROI including TB, maternal health and paediatrics.

One cause for concern that is coming up time and again is that there seems to be no antiretroviral combination that does not cause fat accumulation.

This was highlighted at the 11th International Workshop on Adverse Drug Reactions and Co-morbidities in HIV. Additionally it appears that there is greater prevalence among women and among Black women.

Richard Jefferys from TAG provides an excellent analysis of the controversial results from the RV144 Thai Vaccine Trial in a report from the 9th AIDS Vaccine Conference. Jeffreys has provided a consistent voice of reason as the trial data was released amid a maelstrom of hyperbole.

Other articles include, When to start guidelines in resource poor settings and an overview of ART programme data, and our final reports from IAS2009.

As this is the last HTB South of the year we would also like to take the opportunity to thank our medical board and everyone who has provided invaluable comments and feedback.

And to all our readers Happy New Year!

Probably the most important findings at this conference come from the Development of AntiRetroviral Therapy in Africa (DART) trial. We summarise the main results and pregnancy outcomes in this issue.

We also encourage readers to look at the many presentations that are posted to the study website.
http://www.ctu.mrc.ac.uk/dart

Other reports from this conference include maternal health, breastfeeding and prevention of mother to child transmission, and an overview of TB studies

We also include reports from the Clinical Pharmacology Workshop held earlier in the year, and articles from Richard Jeffery’s blog, which has the best coverage of basic science news.

We have had many questions about swine flu (H1N1) in people with HIV so we lead this issue with a summary from the i-Base Q&A, which may be useful to photocopy for patients and healthcare workers.

We also include a summary of key information and recommendations for management of swine flu and HIV from the South African National Institute of Communicable Diseases (NICD).

Our next issue of HIV South will have further reports from IAS including coverage of paediatric research presented at this conference and at the 1st International Workshop on HIV Paediatrics also held in Cape Town.

Welcome to the fourth issue of HTB South, which contains a wealth of conference reports including from the 16th CROI in Montreal and the 4th Southern African AIDS Conference held in Durban.

Happy reading!

HTB South is supported by a grant from the Monument Trust. Nathan Geffen is remunerated from this grant.

We have included two excellent pregnancy studies from Botswana in this issue and expect a big splash in HTB South number four.

We also include reports from the 9th International Congress on Drug Therapy in HIV Infection, held in Glasgow, and articles from some of our favourite websites including Richard Jefferys’ basic science blog and the University of Liverpool’s HIV drug interaction site.

HTB South is supported by the Monument Trust.

We lead with the news that preliminary results from the OCTANE trial show lopinavir/ritonavir containing HAART to be significantly more effective than nevirapine containing HAART in women who had previously received a single dose of nevirapine to reduce mother to child transmission.

We include conference coverage from the 48th ICAAC and IDSA joint meeting. We also cover a much smaller workshop on transmission held immediately prior to this, which is appropriate given the highlight given to HIV treatment as a prevention tool. This is also covered in some of our reviews of peer-reviewed publications.

Our next issue will include conference coverage, an update on new guidelines and where we are with maternal health and PMTCT.

Happy New Year!

This first issue for Southern Africa is a round up of conference reports from this year. We have included a balance of research conducted in the North and South, both with immediate implications for the region and for future treatment and strategies.

More detailed conference reports can be found on our website:

The next issue of HTB South will include reports from the 2008 HIV/AIDS Implementers’ Meeting – Kampala, Uganda; the XVII International AIDS Conference, Mexico City and the Botswana HIV Conference, Gaborone.

HTB South is distributed electronically by HIV i-Base and the Southern African HIV Clinicians Society.

This issue was produced for the Botswana HIV Conference, 17-20 September 2008, Gaborone.

HTB South is supported by the UK Department for International Development (DfID).