XVIII International AIDS Conference: 18-23 July 2010, Vienna
Treatment access will always dominate the programme of World AIDS Conferences. Since the Durban conference in 2000, every scientific advance at this meeting is rightly seen in the context of which populations, in a global health emergency, will have the opportunity to benefit.
This is one of the strengths of this meeting, which now has over 20,000 delegates, and many of the access-related sessions are online as webcasts and transcripts produced by the Kaiser Foundation.
A joint report from UNAIDS and Kaiser launched prior to the conference clearly and disturbingly showed that international donor funding, which now supports close to five million people on treatment, has leveled. This threatens to overturn the accumulated health benefits from the last ten years. Flat-lined funding means treatment programmes will be closed to new patients and this will have a disastrous impact on HIV prevention.
Without treatment, not only is there little incentive to test, and an increase in AIDS and death, but also the beneficial impact that antiretroviral therapy has on the risk of transmission will be reduced. And treatment is still likely to be more effective in preventing HIV than any other intervention.
This global crisis demands international support, and this involves funding. So while the US leads funding initiative, as the worlds richest country, it is just as important that other wealthy nations meet, for example, the commitments made at the G8 summit. The expense and investment in the conference itself, did not sit easily with the decision to hold the meeting in country that has not supported the Global Fund since 2002. Currently the Global Fund to Fight AIDS, TB and Malaria (GFATM) is faced with a $3 billion shortfall for 2010. Similarly, very few African nations have met their pledge in the Abuja Declaration 2001 to target at least 15% of GDP on healthcare.
The global demand for treatment challenges the concept of universal access using todays medications. Research into ARV drug delivery using nanotechnology is proceeding extremely slowly with only one abstract at this meeting, and yet this has the potential to address many obstacles to wider access. The volume of active ingredient is dramatically reduced with a nanoformulation requiring perhaps monthly dosing, both of which dramatical reduce costs.
This was a conference that highlighted access issues from a human rights perspective:
- The Vienna Declaration – is the official conference statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies
- Many sessions addressed access to evidence-based harm reduction stategies including opioid substitution therapy (OST)and needle exchange progammes.
- Access to treatment to prevent mother-to-child transmission (PMTCT) currently only 1020% of HIV-positive women worldwide are able to access testing and treatment during pregnancy.
- The criminalisation of same sex relationships and discrimination against men and women whose sleep with partners of the same sex, highlighted most recently by extreme cases in Uganda, Malawi and Iran, was the focus of several sessions.
We will cover treatment access in the next issue.
In terms of medical and scientific research, there were a few important headline-grabbing studies and a good selection of interesting but preliminary research findings.
As with all meeting reports we include links to original abstracts and webcasts when available, and for this meeting we also start with a guide on how to navigate the conference website for other material.
Abstracts from the conference are published on the conference website: http://www.aids2010.org/
Reports in this issue include:
- Navigating the conference online
- Results from the Caprisa 004 tenofovir microbicide trial
- Quadrivalent HPV vaccine reduces genital lesions and HPV acquisition in men
- Rilpivirine (TMC-278) vs efavirenz in treatment-naive patients: phase 3 results
- Once-daily nevirapine extended release (XR) is non-inferior to current formulation
- GSK572: second-generation integrase inhibitor
- TBR-652: early results for CCR5 inhibitor
- Maraviroc vs atazanavir/r in treatment-naive patients
- Unboosted twice-daily atazanavir plus raltegravir
- CASCADE analysis of when to start treatment
- Impact of antiretroviral PMTCT prophylaxis regimens on subsequent maternal disease progression in Kesho Bora
- Birth outcomes with antiretroviral exposure
- New WHO guidelines for children
- Early treatment for infants is cost-effective
- No difference in outcomes for children initiating treatment with a protease inhibitor or an NNRTI nor with viral load switching strategies in PENPACT-1
- Tablets more acceptable than syrups in the ARROW trial
- Paediatric formulation of TMC 278
- Smoking and atazanavir levels
- Darunavir/ritonavir and rosuvastatin
- Lime juice is not a microbicide: do not try at home