From 'What if' to 'What Now': Implementing the New Prevention Technologies

Via AIDSMap, by Gus Cairns.

Two consecutive sessions at the sixth International AIDS Society conference in Rome yesterday were devoted, now we have convincing scientific data on the benefits of treatment as prevention and PrEP, to putting these new prevention methods into practice.

“We have moved from ‘What if?’ to ‘What now?’” was the comment of Mitchell Warren, Executive Director of the AIDS Vaccine Advocacy Coalition (AVAC), on what else we need to know, what barriers need to be addressed , and what resources might be required, to maximise the promise of antiretroviral-based prevention.

Anthony Fauci, Director of the US National Institute of Allergies and Infectious Diseases (NIAID), said: “We now have a solid scientific foundation to say that even in the absence of a vaccine we have the capacity to end the epidemic. I can’t go to the US President and say: 'We can cure HIV.’ But I can say ‘Ending the epidemic is scientifically doable’.”

Earlier, however, Nancy Padian from the Office of the US Global AIDS Coordinator had outlined formidable challenges still to be answered if antiretroviral treatment could bring about this goal.

She said that questions still needing answers include whether antiretroviral drugs (ARVs) really are a durable and reliable means of viral load suppression over a period of years and whether increasing the proportion of people on treatment would lead to increased levels of resistance. The biggest practical question, however, was whether treatment as prevention would work in situations where a high proportion of transmissions came from people with acute, recent HIV infections.

The biggest barriers to treatment as prevention, however, are stigma and lack of resources. Implementing ARV-based prevention would not only be expensive in terms of drugs; it would require added human resources and increased training and task-shifting for prevention counsellors so they can deal with biomedical data. There would also be added costs in terms of tests and monitoring.

The other big barrier will be the stigma of being tested, she said, particularly for at-risk populations in societies where injecting drug use, male-male sex, or sex work were criminalised and stigmatised. Treatment as prevention would require people not simply to test and then go to more supportive community organisations for prevention advice; it required a much closer relationship with medical personnel who might be prejudiced or feared to be so.

Mitchell Warren issued a call to action to implement the new strategies, but his presentation was tempered by realism. “We have evidence, we have data, and we now need to make decisions,” he said.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 4 Press Release

OFFICIAL PRESS RELEASE – DAY 4

16.30 (CET), WEDNESDAY JULY 20

Late Breaker extracts - newsmakers

First global study of real-world circumcision rollout conducted over three-year period in South Africa amongst 110,000 adults shows a marked reduction (>60%) of HIV acquisition among circumcised adult men .

Elvitegravir once-daily is non inferior to raltegravir twice-daily in treatment experienced patients

iPrEx study: new, long-term data from the first large-scale clinical trial to demonstrate the efficacy of oral pre-exposure prophylaxis shows the durability of PrEP for HIV prevention

Wednesday, 20 July, 2011 (Rome, Italy) -- Researchers presenting late breaking research  on the final day of  the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) have today focussed on new studies in the field of circumcision, pre-exposure prophylaxis (PrEP) and antiretroviral treatment. The IAS 2011 conference has been attended by over 5000 researchers, clinicians and community leaders since Sunday in Rome.

• The roll-out of male circumcision in the South African township of Orange Farm (ANRS 12126) is curbing the spread of HIV ( 16.30-17.30, SR2)

B. Auvert1, D. Taljaard2, D. Rech2, P. Lissouba3, B. Singh4, D. Shabangu2, C. Nhlapo5, J. Otchere-Darko2,T. Mashigo2, G. Phatedi2, R. Taljaard2, M. Tsepe2, M. Chakela2, A. Mkhwanazi2, P. Ntshangase2, S. Billy5,D. Lewis4

1Univeristy of Versailles, Versailles, France, 2Progressus, Johannesburg, South Africa, 3Inserm 1018, Villejuif, France, 4NICD-NHLS, Johannesburg, South Africa, 5SFH, Johannesburg, South Africa

Three years after the start of the male circumcision roll-out (ANRS 12126) in the South African township of Orange Farm (110 000 adults), a reduction in HIV prevalence and incidence among men has been observed. These findings demonstrate for the first time that male circumcision roll-out is effective at community level in curbing the spread of HIV. This research is coordinated by Inserm U1018/UVSQ and conducted by Progressus (South Africa), the National Institute of Communicable diseases of the NHLS (South Africa) and is financed by the French National Agency for Research on AIDS and Viral Hepatitis ANRS.

"The real-world effect of the roll-out of medical male circumcision (MMC) on the HIV epidemic has been until today, unknown,” said Professor Bertran Auvert, Professor of Public Health at the University of Versailles and  principal investigator of  the  study.

“This study demonstrates that adult male circumcision works to reduce the spread of HIV in an African community highly affected by the epidemic. Reducing the number of new infections with adult male circumcision will save lives and reduce the need for antiretroviral therapy. This study shows also that the roll out of adult safe male circumcision should become a top health priority in Southern and Eastern Africa and that a strong political commitment is needed now,” concluded Auvert.

• Completed observation of the randomized placebo-controlled phase of iPrEx: daily oral FTC/TDF pre-exposure HIV prophylaxis among men and trans women who have sex with men (16.30-17.30, SR2)

 R. Grant1,2, V. McMahan1, A. Liu3, J. Guanira4, M. Casapia5, J. Lama4, T. Fernandez6, V. Veloso7, S. Buchbinder3, S. Chariyalertsak8, M. Schechter9, L.-G. Bekker10, K. Mayer11, E. Kallas12, P. Anderson13, K.R. Amico14, D. Glidden2, for the iPrEx Study Team

1Gladstone Institutes, San Francisco, United States, 2University of California - San Francisco, San Francisco, United States, 3San Francisco Department of Public Health, San Francisco, United States, 4INMENSA, Lima, Peru, 5ACSA, Iquitos, Peru, 6Equidad, Guayaquil, Ecuador, 7FIOCRUZ, Rio de Janeiro, Brazil, 8RIHES, University of Chiang Mai, Chiang Mai, Thailand, 9Project Praca Onze, Hospital Escola Sao Francisco de Assis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 10Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa, 11Fenway Health, Boston, United States, 12University of Sao Paulo, Sao Paulo, Brazil, 13University of Colorado Denver, Aurora, United States, 14University of Connecticut, Storrs, United States

New research will be presented from investigators of the iPrEx study, the first large-scale clinical trial to demonstrate the efficacy of oral pre-exposure prophylaxis (PrEP) as HIV prevention. Data presented here demonstrate that the HIV prevention impact of PrEP was durable throughout the iPrEx study and across participant subgroups, with no evidence of HIV drug resistance among individuals infected with HIV after starting PrEP and a very low rate of side effects.

"PrEP is an important HIV prevention tool with the potential to prevent significant numbers of new HIV infections," said iPrEx Protocol Chair Robert Grant, investigator at the Gladstone Institute of Virology and Immunology in San Francisco and Associate Professor of Medicine at the University of California.

"These data confirm that PrEP is safe and effective in MSM, one of the populations most affected by HIV worldwide. A four-continent open-label extension of the iPrEx study is underway. Global and national public health experts and advocates should work expeditiously to determine how to best make this lifesaving HIV prevention tool available for MSM, who bear the brunt of the epidemic in many parts of the world, “concluded Grant

• Results of the Gilead 145 trial: Elvitegravir once-daily is non inferior to raltegravir twice-daily in treatment experienced patients: 48 week results from a phase 3 multicenter, randomized, double blind study (16.30-17.30, SR1)

 J.-M. Molina1, A. LaMarca2, J. Andrade Villanueva3, B. Clotet4, N. Clumeck5, Y.-P. Liu6, L. Zhong6, A. Cheng6, J. Szwarcberg6, S.L. Chuck6, for the Study 145 Group

1Hopital Saint Louis, Paris, France, 2Therafirst Medical Center, Fort Lauderdale, United States, 3HospitalCivil de Guadalajara, CUCS, U de G, Guadalajara, Mexico, 4Hospital Universitario Germans Trias i Pujol, Barcelona, Spain, 5C.H.U. St Pierre, Brussels, Belgium, 6Gilead Sciences, Foster City, United States

This is the first head to head comparison of elvitegravir an investigational once-daily HIV integrase inhibitor to raltegravir, the only approved integrase inhibitor today.

In this international phase III study involving 234 sites in United States, Europe, Canada, Mexico, Australia and Puerto Rico, 702 HIV-infected patients failing their current antiretroviral regimen with drug-resistant viruses, were randomized to receive in a double-blind fashion either once-daily elvitegravir or twice daily raltegravir in combination with a boosted protease inhibitor and a third agent. The primary efficacy endpoint at week 48 demonstrated similar efficacy of the two regimens with a virologic response rate (plasma HIV viral load below 50 copies/ml) of 59 and 58% in the elvitegravir and raltegravir arms, respectively using an intent to treat analysis, with a treatment difference of 1.1% (95% CI : -6.2;8.2).

The safety of the two regimens was also similar with only 2-3% of patients in both arms discontinuing treatment because of adverse events. Finally, the emergence of integrase resistance among patients with virologic failure was only 27% and 21% in the elvitegravir and raltegravir arms, respectively.

Overall, these results demonstrate the efficacy and safety of elvitegravir in combination with a ritonavir-boosted protease inhibitor for treatment-experienced patients, and position elvitegravir as an alternative once-daily integrase inhibitor. 

“For many people, HIV treatment might just have got simpler,"   said Jean-Michel Molina, the study’s principal investigator and Head  of   the  Department of Infectious Diseases at the  Hopital Saint Louis in Paris. “This  study is good news  for people living with HIV -  pending FDA approval they  will  now have available a new antiretroviral drug that only needs to be taken once a day which in itself will also promote better adherence,” concluded Molina.
[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Growing sense of hope at international Aids conference

From the Guardian, by Sarah Boseley.

There appears to be real excitement at the International Aids Society conference in Rome (sadly I'm not there in person, but that is the feedback). There is still no vaccine on the horizon - once the biggest hope - but the news from recent studies that taking antiretroviral drugs protects people without HIV from infection (see the story here) and reduces the risk of people with HIV passing it to their partners (here) has changed the landscape. Suddenly we are in a world where Aids is more preventable than ever before - and both prevention and treatment come pill-shaped.

So there is no shortage of important people calling for more funds and more action to roll out drugs to the nine million people in developing countries estimated to need them right now. Michel Sidibé, executive director of UNAIDS, said it was an affront to humanity that there were gaps in coverage.

"We have to remember that history will judge us not by our scientific breakthroughs, but how we apply them," he said.

There are practical difficulties in the way of getting the drugs to all who need them, but beyond the rhetoric and the big picture, there are organisations which are trying to find better ways forward. The Drugs for Neglected Diseases Initiative, for instance, which has been doing excellent work on a select group of conditions - human African trypanosomiasis, leishmaniasis, Chagas disease and malaria - has decided to take on the needs of children with HIV. Paediatric formulations of antiretrovirals are inadequate. Children are not small adults. They don't just need a few less tablets - they need drugs that can be given in doses suitable for their weight and may need syrups rather than pills. This is Dr Bernard Pécoul, executive director of DNDi:

"There are millions of children with HIV/AIDS in low- and middle-income countries, but their needs are absent from the HIV research and development agenda, and this is largely because they are poor and voiceless and do not represent a lucrative market. Working with partners, we hope to help fill this terrible gap and offer improved treatment options for children with HIV/AIDS."

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 3

Today is Day 3 of the exciting conference happening in Rome, and IRMA has a lot of interesting information to report. Here is the press release for Day 3, and below it are links to important and fascinating presentations from and articles about the conference.

Via IAS.

OFFICIAL PRESS RELEASE – DAY 3

                                                         EMBARGOED UNTIL 11.00 (CET), TUESDAY JULY 19

Plenary speakers address challenges in the delivery of sustained antiretroviral therapy in developing countries, call for social scientists to take their place at the HIV/AIDS policy- making table, and stress the need for a long-term response to AIDS

Tuesday, 19 July, 2011 (Rome, Italy) -- Researchers speaking in the second plenary session of the 6^th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) have today provided insights into the future direction of HIV/AIDS policy making and alerted delegates to the challenges that developing countries continue to face in the delivery of large- scale antiretroviral therapy (ART) coverage.

The presentations reflect the breadth of expertise among the more than 5,000 researchers, clinicians and community leaders attending the conference, which runs from 17-20 July in Rome.

“The AIDS response up until now has led to unprecedented mobilization of populations and significant progress in terms of prevention and treatment,” said IAS 2011 International Chair and IAS President Elly Katabira. “However, given the projections we have made of infections over the next decade, together with the growing number of people living longer with HIV, it makes perfect sense to discuss whether a remodeling or fine-tuning of that response might more effectively meet the new challenges that lie ahead.”

“Discussion around the future direction of HIV/AIDS policy must begin to give a far greater voice to the social sciences,” said Stefano Vella, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS).  “The social and political sciences are a vital element in helping us to improve prevention efforts, especially in developing countries where major challenges remain in the effective roll-out of ART.”

The Social Barriers to Effective HIV Prevention

In her plenary remarks, Susan Kippax (Australia), Emeritus Professor at the Social Policy Research Centre, University of New South Wales, Sydney, suggested that in understanding HIV prevention efforts, people’s behaviours cannot be separated from their social, cultural and political structures, and the biomedical cannot be distinguished from the non-biomedical. Kippax argued that there is a need for social scientists to be at the table when it comes to discussing what many experts currently consider to be the greatest challenge to HIV/AIDS policy making - prevention.

Irrespective of whether prevention programmes or interventions advocate the use of condoms, clean needles and syringes, microbicides, pre- or post-exposure prophylaxis, or treatment as prevention - all prevention requires that people change their social practices: changes which cannot be effectively sustained unless they are supported by broader social transformation.

Challenges of Antiretroviral Therapy (ART) in Developing Countries

Serge Eholié (Ivory Coast) Professor of Tropical and Infectious Diseases at the Medical School of the University of Abidjan, focused on the challenges of sustaining antiretroviral therapy initiatives in developing countries.

A decade after the first antiretroviral therapy initiatives were initiated in developing countries, the number of HIV-infected individuals receiving ART has significantly increased. Recent data estimate that six million HIV-infected patients started ART and four and a half million of them (75 per cent) live in sub-Saharan Africa, and significant results have been obtained in decreasing mortality and morbidity.

Seven areas were identified as challenging in the ongoing delivery of ART in developing countries:

• financing the sustainability of ART-programmes, particularly in the context of the current adverse economic climate and with insufficient contributions from national governments;
• the high incidence of mortality and severe mortality during the first year following ART-initiation;
• the adaptation of programmes, physicians, countries and partners to the WHO 2010 revised guidelines for adults and adolescents;
• an increasing number of HIV-infected patients failing first-line treatment: the cost of second line treatment is four to five times higher than first line regimes. It is challenging for countries and partners to afford second line treatment, and difficult for physicians to detect first-line failure early enough;
• detectingfirst-line treatment failure earlier and prescribing an effective and safe second line regimen in light of the expense of the latter;
• management, diagnosis and treatment of side effects; 
• retention of patients: data for cohorts studies show that 25%-30% of HIV patients starting treatment are lost to follow up after 12-24 months;
• socio-political instability and humanitarian crisis and natural disasters

 AIDS: The Need for a Long-term Response

Peter Piot (Belgium), Director of the London School of Hygiene & Tropical Medicine, London, concluded the plenary session by reflecting that given the enormous mortality and human suffering caused by the AIDS epidemic, the nature of the global response to the AIDS epidemic has been framed as an emergency. Yet the ultimate duration of the emergency has rarely been discussed.

In spite of a recent decline in interest and funding for AIDS, UN member states recently adopted a "Political Declaration on HIV/AIDS: intensifying our efforts to eliminate HIV/AIDS" with ambitious goals for the next five years. Projections from aids2031 and UNAIDS estimate that over the coming two decades,  there may still be one to one and a half million new infections and one million deaths annually, with resources required to curb infections well in excess of currently available funds.

The combination of these developments, as well as the longer life expectancy of many people infected with HIV, provides a compelling argument for the need for a long term view on the AIDS response. In addition, resource constraints dictate that effective investments leading to the best possible outcomes in both the short and long term are necessary, and right now.

 ---

 Session abstracts and presentations for "Novel Approaches to Prevention Interventions and Measurement" can be found here. Especially of note for rectal microbicide advocates is this presentation.

Also of interest is this abstract of work done by IRMA - Nigeria: "Mobilizing MSM community in Nigeria to support rectal microbicides development", and the abstracts/powerpoints in this session: "Treatment Is Prevention: The Proof Is Here".


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 2 Press Release

OFFICIAL PRESS RELEASE – DAY 2

16.30 (CET), MONDAY JULY 18

Antiretroviral Treatment is HIV Prevention: The proof is here

Leading researchers and international experts to discuss the policy and prevention implications of three groundbreaking trial results: the HPTN O52 study, the Centers for Disease Control and Prevention TDF2 study and the University of Washington Partners PrEP Study

Monday, 18 July, 2011 (Rome, Italy) -- A special press conference at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) will today feature a panel consisting of researchers from the CDC TDF2 study, the Partners PrEP Study and the HPTN 052 study. They will be joined by Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), Gottfried Hirnschall, Director of the HIV Department of the World Health Organization (WHO) and Elly Katabira, IAS 2011 International Chair and President of the International AIDS Society (IAS). The IAS 2011 conference opened yesterday, Sunday 17 July and runs until Wednesday 20 July and is being attended by over 5000 researchers, clinicians and community leaders.

In light of announcements this past week about new data on PrEP effectiveness, both the HPTN 052 abstract session (16.30, SR1) and press conference have been expanded to include presentations on the Partners PrEP Study and the CDC’s TDF2 study, both of which were released on 13 July in the US. The presentation on the CDC study was originally scheduled for a late breaker session at IAS 2011 on Wednesday 20 July.

“Treatment is prevention and these three studies provide the proof,” said Katabira.

“The XI International AIDS Conference in Vancouver in 1996 is remembered as the conference that heralded the arrival of combination antiretroviral treatment. The IAS 2011 Conference will be remembered as the beginning of the treatment as prevention revolution.”

“These studies mark a turning point in HIV science and in HIV prevention,” said Stefano Vella, IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS). “The urgent challenge now is to implement treatment as prevention in the developing world.”


Press conference line up:

Chair: Stefano Vella: IAS 2011 Local Co-Chair and Research Director at the Istituto Superiore di Sanità (ISS)


Myron Cohen: HPTN 052 Protocol Chair and Associate Vice Chancellor for Global Health and Director of the Institute of Global Health and Infectious Diseases at the University of North Carolina

About the HPTN 052 study:

The HIV Prevention Trials Network (HPTN) 052 study found that men and women, who were already infected with HIV, had a reduced risk of transmitting the virus to their uninfected sexual partners by 96% through early initiation of combination antiretroviral therapy (cART). HPTN 052 also found that early initiation of cART benefits the HIV-infected individual.

HPTN 052 was designed to evaluate whether early versus delayed use of cART by HIV-infected individuals would reduce transmission of HIV to their uninfected partners and benefit the HIV-infected individuals as well. During the course of the study, 39 participants who had been HIV-uninfected at the start of the study became infected with HIV. Of those, 29 were linked transmissions, where the virus from the originally-infected partner was confirmed by genetic analysis to be the source of infection in the newly infected sexual partner. Only one of the 29 infections occurred in the early cART arm. Based on the latest analyses, this one transmission most likely occurred close to the time the couple enrolled in the study and before HIV viral replication could have been suppressed by cART in the infected participant.

The new analyses also provide more insight as to how early initiation of cART benefits the HIV-infected person. Individuals who were put on early cART maintained higher absolute CD4 counts than those in the delayed arm, who received treatment when their CD4 counts fell below 250 cells/mm³ or an AIDS-related event occurred. Early cART was also associated with a 41% reduction in HIV-related illnesses or death, a direct benefit for the HIV-infected partner. The reliable suppression of HIV among HIV-infected people in the early treatment arm suggests potential impact on adherence when the infected individual is informed that their cART may also benefit their partner.


Michael C.Thigpen: Principal study investigator and epidemiologist at the Centers for Disease Control and Prevention (CDC), USA

About the TDF2 study:

The CDC TDF2 study was a randomized, placebo-controlled trial examining the safety and efficacy of a once-daily tablet containing tenofovir disoproxil fumarate and emtricitabine (TDF/FTC, known by the brand name Truvada) for reducing the risk of HIV acquisition among heterosexual men and women at two sites in Botswana. In addition to study medication, all participants received a comprehensive package of HIV prevention services. The study provides strong evidence that a daily oral dose of antiretroviral drugs used to treat HIV infection can reduce HIV acquisition among uninfected individuals exposed to the virus through heterosexual sex. The study, conducted in partnership with the Botswana Ministry of Health, found TDF/FTC reduced the risk of acquiring HIV infection by roughly 63 percent overall in the study population (95% CI, 21.5 to 83.4; p= 0.0133) ,and by 78 percent among trial participants believed to be taking study medications (95% CI 41.2 to 93.6, p=0.0053). Adherence (as measured by pill count) was high, both among those receiving TDF/FTC and those receiving placebo (84.1 percent and 83.7 percent, respectively). Reported sexual risk behavior was similar between the two study arms. Consistent with other PrEP studies, preliminary analyses did not identify any significant safety concerns associated with daily use of TDF/FTC.


Jared Baeten: Co-leader of the Partners PrEP Study and epidemiologist at the University of Washington, USA

About the Partners PrEP Study:

This is a phase III, randomized, double-blind, placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir for the prevention of HIV-1 acquisition among HIV-1 seronegative partners in heterosexual HIV-1 serodiscordant partnerships. The study is funded by the Bill & Melinda Gates Foundation. The University of Washington coordinated the trial, in collaboration with investigators at nine sites in Kenya and Uganda. The study enrolled 4758 HIV-1 serodiscordant couples; HIV-1 uninfected partners were randomly assigned in equal numbers to one of three study groups: one group received tenofovir, one emtricitabine/tenofovir, and one matching placebo. All study participants received a comprehensive package of HIV-1 prevention services. On 10 July 2011, the Partners PrEP Study independent Data and Safety Monitoring Board (DSMB) recommended, after review of the study data, that the study results be publically reported and the placebo arm be discontinued, because of definitive demonstration of HIV-1 protection from pre-exposure prophylaxis (PrEP) in the study population. Tenofovir reduced HIV-1 risk by 62% (95% CI 34 to 78, p=0.0003), emtricitabine/tenofovir by 73% (95% CI 49 to 85, p<0.0001). Efficacy for tenofovir and emtricitabine/tenofovir were not statistically different. 62% of HIV negative participants were male, 38% were female: both PrEP medications reduced HIV-1 risk in men and women. Adherence to the daily PrEP medication was very high – more than 97% of dispensed doses of the study medications were taken. More than 95% of participants were retained in study follow-up. Safety parameters were comparable across the three study groups.


Anthony Fauci: Director, NIAID, USA

Fauci will remark on the implications for prevention research. He will talk about the collective importance of these studies in finding new HIV prevention methods and the optimism that these combinations when viewed in total will help to end the HIV/AIDS epidemic.


Gottfried Hirnschall: Head of the HIV Department at the WHO, Switzerland

Over the past year, WHO has been developing recommendations for couples HIV testing and counseling. More than half of all people living with HIV do not know their infection status, and therefore, may transmit HIV unknowingly. By partners testing together and mutually disclosing their test results, couples can learn about their options for HIV prevention and treatment.

The findings of the three cited studies above will be reflected in WHO guidelines for couples HIV testing and counseling and also to develop broader guidance on the strategic use of antiretrovirals for treatment and prevention of HIV.


Elly Katabira: International Chair IAS 2011 and IAS President

Katabira will talk about the implications of the three cited studies for HIV professionals


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011: Day 1 Press Release

The 6^th IAS Conference on HIV Pathogenesis, Treatment and Prevention began yesterday in Rome, Italy. Here is the press release from yesterday's events:

OFFICIAL PRESS RELEASE – DAY 1

17.00 (CET), SUNDAY JULY 17

AIDS is at a scientific watershed, says IAS 2011 International Chair Elly Katabira at the opening of the world’s largest open scientific conference on HIV and AIDS

Michel Sidibé, UNAIDS Head, adds that history will judge us not by our scientific breakthroughs on AIDS, but how we apply them

Sunday, 17 July, 2011 (Rome, Italy) - More than 5,000 AIDS researchers, scientists, clinicians, community leaders and policy experts gathered in Rome for the opening of the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) have welcomed the growing momentum in biomedical research, but have warned that the benefits of these advances need to be evenly shared between the global North and South. Opening Session speakers also used this occasion to call on the Italian government to re-commit to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“We are at a scientific watershed in the global AIDS response,” said IAS 2011 International Chair and International AIDS Society President Elly Katabira. “We have witnessed two years of significant biomedical advances, the likes of which we have not seen since the antiretroviral breakthroughs of the mid 1990s. The excitement around these advances in research - whether they be the CAPRISA 004 vaginal gel, the HPTN 052 study on treatment as prevention, talk around the path towards a cure, or the encouraging signs on PrEP and vaccines – is very much driving the debates and discussions that we are going to see in Rome over the next few days.”

“IAS 2011 delegates, like many professionals working in the international response to HIV, are understandably excited about recent scientific breakthroughs. However, we need to ensure that the advances we are making in research such as the now proven concept of antiretroviral treatment as a means of HIV prevention – is translated into action for people in developing countries,” said IAS 2011 Local Co-Chair Stefano Vella, Research Director at the Istituto Superiore di Sanità (ISS). “Advances in science need to be matched by advances in resourcing. I call on the Italian government to recommit itself as a donor nation to the Global Fund to Fight AIDS, Tuberculosis and Malaria.”

In an Opening Session keynote speech, UNAIDS Executive Director Michel Sidibé said that gaps in access to HIV treatment within and between countries and key populations were an affront to humanity that can and must be closed by innovations in developing, pricing and delivering treatments and commodities for HIV, TB, malaria, reproductive health and other health issues.

“We have to remember that history will judge us not by our scientific breakthroughs, but how we apply them,” said Sidibé.

The IAS Conference series focuses on the translation of research into practice, particularly in low- and middle-income countries.


Opening Session

The emphasis on the real-world application of science was also reflected in today’s Opening Session, which began with welcoming remarks by IAS 2011 Co-Chairs, a message from Giorgio Napolitano, President of the Republic of Italy, an address from Giovanni Alemanno, Mayor of Rome, followed by a community welcome by Filippo von Schloesser, President of Fondazione Nadir Onlus. Mr von Schloesser said the Italian government‘s waning commitment to HIV/AIDS was a major concern to people living with HIV.

IAS 2011 will reveal promising new data across all four scientific tracks – particularly in the areas of HIV treatment as prevention, HIV cure efforts, new drugs and new antiretroviral combinations, and the scale up of effective prevention and treatment interventions in resource-limited settings. From a scientific perspective, this is a time of optimism which was last seen in the mid 1990s, when the promise of combination antiretroviral therapy (ART) first became real. IAS 2011, while urging governments and donors to commit to continued and increased commitment to HIV and AIDS across all programme areas, will stress the necessity to respect the Sydney declaration – the declaration released during the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention, which stated that 10 per cent of all HIV funding should go on research.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Treatment as Prevention – The Tough Road Ahead

Via PlusNews.

The sixth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention started optimistically as the hype surrounding the use of antiretroviral treatment to prevent HIV infection gained momentum. But the focus of much discussion in Rome from 17-20 July will undoubtedly be on how to transform the recent promising research findings into workable policy.

The most significant of these is the HPTN052 randomized control trial, which found that earlier antiretroviral treatment can reduce the risk of heterosexual HIV transmission by as much as 96 percent; other studies have proven the efficacy of ARVs for prevention in HIV-negative people.

"We need to ensure that the advances we are making in research – such as the now proven concept of antiretroviral treatment as a means of HIV prevention – are translated into action for people in developing countries," said IAS local co-chair Stefano Vella, research director at Italy’s Istituto Superiore di Sanità, at the official opening of the conference.

But translating the research into action will require money, and if recent trends are any indication, that will be difficult, and there is much scepticism about the ability to significantly increase the numbers on treatment with such limited funds.

Donor pressure
"We need to keep up the pressure on donors... Donors are used to seeing costs rising year after year, but now we can show them a light at the end of the tunnel... We can show them that investing today will lead to lower costs tomorrow," Brenda Waning, coordinator of market dynamics with the health financing mechanism, UNITAID, said. "We also need to learn how to do more with limited resources."

Treatment as prevention will mean putting significantly more people on treatment earlier; at present, 15 million people are estimated to need ARVs – only 6.6 million have access to them.

"Treatment as prevention is possible, it is feasible, but we must not fool ourselves into thinking it's going to be easy," said Paul de Lay, deputy executive director of UNAIDS. "We put an additional 1.4 million new people on treatment in 2010 – if we maintain that momentum we will not achieve the goal of 15 million on treatment by 2015.

"We need to get to US$22 to $24 billion a year from the $15 billion a year we are currently spending; we need African governments to abide by the Abuja Declaration commitment to spend 15 percent of national budgets on health and we need donors to meet their commitments," he added.

"If we can convince donors that we can stop the epidemic within a finite amount of time, the money will be found," said Brian Williams, an epidemiologist with the UN World Health Organization (WHO).

Scaling-up HIV testing
Key to putting more people on treatment earlier will be finding those who need it; according to De Lay, most countries with hyper-endemic epidemics are testing just 4 percent of their populations.

Read the rest here.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

AIDS conference opens in Rome

This the beginning of IRMA's coverage of the IAS conference in Rome which opened yesterday, and which is being attended by several IRMA advocates.

Via Associated Press, by Alessandra Rizzo.

The head of the United Nations AIDS program called Sunday for an increase in access to drugs that help treat or prevent the spread of the disease, saying it is "morally wrong" to keep millions of people off lifesaving medication.

Michael Sidibe, executive director of UNAIDS, said the gap in access to HIV treatment should be closed both within and between countries.

Sidibe called for better delivery on the ground, a reduction in the number of years it now takes to turn scientific discoveries into actual progress for the poor, and increased cooperation among states, pharmaceutical companies and international organizations.

"We must use innovation to overcome social division and inequity," he said at the opening of an international AIDS conference in Rome.

In Africa, the hardest hit continent, 6.6 million people are now on AIDS medication, but 9 million people eligible for treatment are on waiting lists, according to the World Health Organization. In the United States, many state assistance programs that help people access AIDS medications also have waiting lists.

"Most of those people don't know what'll happen to them. Do we tell them that they should die?" Sidibe said. "Having 9 million people wait day and night with their families is morally wrong. It is socially unacceptable."

The conference opened a few days after the announcement of a significant scientific breakthrough in stopping the spread of the virus: Two studies conducted in Africa showed that an antiretroviral drug made by United States firm Gilead Sciences already known to help prevent the spread of the virus in gay men also works for heterosexual men and women, researchers said. One of the studies showed the drug lowered the risk of infection for those believed to be regularly taking the pills by roughly 78 percent, the researcher reported.

In both studies, participants were also offered counseling and free condoms, which may help explain the relatively low overall infection rate.

According to figures provided at the conference, more than 25 million people have died of AIDS-related illnesses since the beginning of the pandemic 30 years ago, and an estimated 33.3 million people are currently living with HIV. Every day, 7,000 people across the world are infected, and more than 4,900 die from AIDS-related illness.

Even as conference speakers hailed the encouraging scientific advances, questions remained unanswered: How to make sure people remain on treatment, how to achieve universal coverage and how to reduce the risk of people abandoning condoms? Sidibe said these questions needed urgent answers.

And, he added, any discovery must be translated more quickly into policies accessible to those who need treatments, particularly in poor nations. Sidibe also said any trade agreement that would limit access to medication, especially generic ones, should be opposed.

That concern was shared by Elly Katabira, the president of the International AIDS Society and conference chair, who said: "I hope our voice will be heard in asking that access to all drugs, including generic drugs, will not be diminished by new laws or regulations anywhere in the world."

Gilead Sciences Inc., based in California, is a major producer of AIDS drugs. Two of its pills — Truvada and Viread — were used in the recent studies conducted in Botswana, Kenya and Uganda. The company has recently agreed to allow a range of its AIDS drugs to be made by generic manufacturers, potentially increasing their availability in poor countries.

The conference organized by IAS gathers some 5,000 researchers, scientists, clinicians and public health experts. It runs through Wednesday.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

At Home or in Rome, Online Resources to Keep You Connected to IAS 2011

The 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) kicks off on Sunday, 17 July and promises to offer a wealth of important scientific news, including the first full presentation on HPTN 052 and new data on a wide-range of topics including elite controllers, gene therapy, effectiveness of existing treatment regimens, co-infections, microbicides, PrEP, task-shifting, and decentralization of care. There are a number of online resources for those following at home and those attending the conference. All can be accessed through the conference website.

Programme-at-Glance
The Programme-at-a-Glance (PAG) will include slides with audio from more than half of the sessions, including all plenary sessions and most oral abstract sessions. Audio/slides for most sessions will be posted within six hours, though in some cases it will take 12-24 hours.

Abstracts
Abstracts will be available through the PAG and posted at the time of presentation.

Rapporteur Reports
Rapporteurs will prepare summaries of all sessions along with daily summaries in each track, available here.

Blog
The Conference Blog is live and already has posts from a variety of guest authors. We’ll be posting more this week and tracking key developments during the conference and encourage your feedback, thoughts and ideas.

Twitter
We are tweeting – @ias2011 – and encourage you to tweet and re-tweet along with us, using #IAS2011.

Facebook
Follow IAS 2011 on Facebook for updates on and links to key sessions and developments, as well as photos, video highlights and interviews.

YouTube
The IAS 2011 YouTube channel has past interviews and talks from conference speakers and leadership and we’ll be adding more from the conference.

Photo Library
Free, high-resolution photos for use by the media and others (with appropriate credit) will be available through the IAS 2011 online media centre.


Online Partners Coverage
News Reports by NAM

NAM will offer news stories on major scientific presentations on aidsmap.com and publish a free daily news bulletin in English and translated into French, Portuguese, Spanish and Russian. Sign up here to receive the bulletin via email.

Scientific Analysis by CCO

Clinical Care Options’ (CCO) online coverage at clinicaloptions.com will begin the week of 17 July and include expert audio highlights, capsule summaries of important clinical data, downloadable slidesets and more.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IAS 2011 HIV Prevention Research Roadmap

Via our friends at AVAC.

Where: Rome, Italy

When: July 17 - July 20, 2011

The IAS Conference on HIV Pathogenesis, Treatment and Prevention is held every two years, and this year it will take place in Rome, July 17-20. The 2011 conference has a program that includes many sessions on a range of HIV-related topics. AVAC has compiled a roadmap that includes the range of HIV prevention research-related sessions planned for the conference. You can download a PDF of the current roadmap here (both detailed and abridged versions).

Or view the conference's Programme-at-a-Glance system, go to pag.ias2011.org and select the HIV Prevention from the roadmap drop-down menu.


AVAC is working with various partners on the following sessions that may be of interest:

Sunday, July 17


•10:15–13:15: Satellite, MR 1: Controlling the HIV Epidemic, the Promise of ARV-based Prevention (A flyer for this session is available.)

•12:30–14:30, Satellite, MR 2: GPP in Action: Introducing the 2nd Edition of Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials and Examples of its Implementation in Current Research

•14:45–16:45: Satellite, MR 2: HIV Vaccines and the Prevention Revolution: Shortening the Path to the End of the Epidemic


Monday, July 18

•18:30–20:30: Satellite, MR 3: Pre-Exposure Prophylaxis (PrEP): How Will the Future Pipeline Look Like?


Tuesday, July 19

•7:00–8:30, Satellite, MR 4: Zeroing out New Infections Through Prevention Tools and Technologies

•16:30–18:00, Bridging Session, SR 1: Use of Antivirals in Prevention—Current Challenges and Controversies
•18:30–20:30, Satellite, MR 3: Can We End the Epidemic?

And, for those of you who won't be attending in person, you can follow the conference proceedings from afar via regular reports from NAM, the official online partner for scientific reporting at IAS 2011, and post-conference coverage from Clinical Care Options (CCO), the official online partner for scientific analysis at IAS 2011. In addition, the Global Health Council will be blogging from the conference. Finally, you may follow IAS 2011 on Facebook and Twitter as well as AVAC on our own AVAC on our own Facebook and Twitter pages for updates.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]