Fifth International Congress on Drug Therapy in HIV Infection, 22-26 October 2000, Glasgow, UK

Reports from the conference

Theo Smart

The 5th International Congress on Drug Therapy in HIV Infection took place from October 22-26, 2000 in Glasgow, Scotland (where at least four of the five Congresses have occurred). This year, the Congress was larger than ever, with more than 3,000 participants from 63 countries. The meeting has also widened its academic sponsorship from its traditionally European base, to include the participation of the International AIDS Society, and the College of Physicians & Surgeons of Columbia University.

The timing of these biannual meetings, roughly three to four months after the World AIDS conference allows clinicians and researchers to assess and respond to the developments of the larger international meeting, and to explore how findings reported apply to their patients. Also, the meeting’s size and location has permitted the expression of a more European perspective (and perhaps, a certain level-headedness) often drowned out in the clamour of the World AIDS conferences.

For example, though encouraged by the successes of HAART at the Vancouver AIDS Conference in 1996, the Europeans remained circumspect about when to initiate treatment. At the Congress on Drug Therapy, a few months later that year, Professor Ian Wellar (Chair of the Scientific Committee) said that in some circumstances he might reserve treatment in patients with a CD4 cell count as low as 180. Many from the US, who believed in treating HIV+ patients as soon as possible, found such a stance far too conservative. Four years later, however, it has become much more common to delay treatment until a patient is closer to being in danger of clinical progression.

The debate about when to initiate treatment turned out to be a key theme of this year’s meeting. Most now wait until a patient’s CD4 cell counts are between 200-500. Even so, where exactly within this range of CD4 cell counts one should start treatment remains uncertain. In a press conference on the first day of the Congress, Prof. Wellar noted “with frequent monitoring, the chance of developing a life-threatening infection above 200 CD4 cells is small and the risk of developing adverse events from long term therapy needs to be taken into account.”

Other considerations weighed in this debate included the risk of failing one’s first regimen, either due to resistance, poor adherence or inadequate drug levels, and strategies for dealing with this failure, including structured treatment interruptions and salvage regimens containing new drugs.

Reports in this issue include:

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