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AIDS XIX 2012 conference: impressions of a South African researcher

Author: Siva Danaviah - 2012-09-12

As a summary of my activities during the meeting, I was able to attend several interesting sessions regarding mother to child transmission, viral latency and of course the viral resistance and an excellent talk on HIV/TB co-infection. Below are a few of the highlights of my experience at AIDS2012.

In the first plenary of the meeting, Anthony Fauci announced that the scientific knowledge now exists for us to envisage an HIV-free generation for the first time in the 3 decades since HIV was first described. Breakthroughs in the field have been incremental over the years and include knowledge of the pathogenic mechanisms of HIV, understanding the early events following infection particularly at the mucosal surfaces, understanding the replication cycle and targets for interventions during this cycle. A key factor is not that we do not have the knowledge but that we implement what we know appropriately. This theme was reiterated throughout the meeting. Given the global economic downturn, several key speakers pointed out the need for resource-poor countries to reduce their complete dependency on funders, seek alternative and innovative funding strategies and ensure the sustainability of existing and future treatment and management programs.

Of interest to the social scientists at the centre would have been a talk by Phil Wilson, an HIV positive gay man who highlighted the worrying epidemic among Black women in the US where approximately 44% of their epidemic is concentrated in only 12 states with the highest rates in the DC area. His talk proposed that in order to end the epidemic biomedical as well as behavioral interventions must be fully integrated. I also met the co-founder of the LIVE Consortium a US group that targets high risk groups including college and high school students for their education and behavioral interventions particularly in the Black communities. The knowledge of HIV he maintains is sorely lacking and there remains significant stigma attached to the disease which I found surprising considering the US's first world status and their interventions in other countries of the world.

It was a great privilege to hear the dynamic and eloquent US Secretary of State Hillary Clinton speak. Her announcement of additional funding for HIV/AIDS research and interventions was welcomed. The message that a multi-factorial approach is essential to eradicate the epidemic appears to have reached the funders as the US now pledged funds to address VTC, TasP, voluntary male circumcision, pMTCT.

Anthony Harries gave an account of HIV/TB co-infection in his plenary and highlighted implementation of integrated HIV/TB programs that include the Isoniazid preventative treatment (IPT) and the Test and Treat strategies to reduce the HIV/TB burden worldwide. He emphasised that in high-burden countries such as ours, parallel ART and TB treatment programs are wholly inadequate to disease prevention or management. Instead, an integrated program aligned to social, behavioural and educational strategies nested within strong management programs would certainly stem the growing HIV/TB co-infection epidemic.

Overall, there was much excitement regarding the amended WHO pMTCT guidelines to include Option B+ but a few voices of reason cautioned that implementation without proper research and infrastructure in place is a recipe for disaster. After listening to the various arguments for and against the large-scale roll-out of Option B+, I wonder if we should perhaps amend the last statement in our Breast Milk paper to suggest B+ only if it is supported by the appropriate infrastructure, management programme and community support. I had the pleasure of chatting with Prof Jerry Coovadia regarding the current and revised WHO pMTCT guidelines. He found it of great concern that the B+ strategy was proposed without an investigation of the short and long term outcomes in women initiated on ART according to the B+ criteria and was eager to pursue a study, with Africa Centre, on the impact of Option B+ on pMTCT success.

My poster was also well received with several useful comments and suggestions on future work. I think it may be of interest to expand the current study of post-natal transmitters to include a study of the viral evolution in peri-natal transmitters to determine whether the timing of the introduction into the breast compartment, among other factors, may account for the timing of transmission (peri, versus- post natal) to the infant. Interestingly, one of the basic scientists to visit my poster was Dr S. Tugizov from UCSF who has a similar interest in MTCT but his focus is the gut mucosa.

Also interesting was the new findings regarding HIV, aging and congenital disease. Again, the Africa Centre was mentioned in this talk. In a growing number of countries, HIV is being managed as a chronic illness with related chronic disorders such as heart disease, osteoporosis and neurological disorders. Evidence of accelerated aging in HIV positive patients was also presented.

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