The XVIII International AIDS Conference has officially started with an opening session focusing heavily on the need for action on human rights and a call by an Australian researcher for greater focus on the prospect of a cure for HIV.
Addressing the meeting, International AIDS Society President Julio Montaner lambasted G8 and G20 countries for their failure to maintain funding for the global HIV response.
“The G8 has, quite simply, failed us,” he said, criticising the use of the global financial crisis as an excuse for the lack of funding because he said the response was already lagging before the crisis occurred.
‘Treatment is prevention’
A major focus of the conference program is the use of HIV treatments to reduce infectivity of people living with HIV as a means to prevent transmission – new initiatives such as ‘Test and Treat’, ‘Treatment 2.0’ and ‘Born HIV Free’ are being energetically debated and promoted. Montaner called this new understanding “a true game changer,” dramatically increasing the return on investment in providing universal access to antiretroviralsA medication or other substance which is active against retroviruses such as HIV..
‘Test and Treat’ is a proposed approach to HIV prevention which focuses on increasing HIV testing and encouraging people who are HIV-positive to start treatment when this is appropriate for them. ‘Treatment 2.0’ is a new protocolA study plan on which all clinical trials are based. The plan is carefully designed to safeguard the health of the participants as well as answer specific research questions. A protocol describes what types of people may participate in the trial; the schedule of tests, procedures, medications, and dosages; and the length of the study. While in a clinical trial, participants following a protocol are seen regularly by the research staff to monitor their health and to determine the safety and effectiveness of their treatment calling for simplified treatments and the use of treatments as prevention in developing countries. ‘Born HIV Free’ is a campaign to eliminate mother-to-child transmission of HIV by 2015.
“As you can see, the consensus is building. Treatment is prevention and universal access is the way forward,” Montaner said.
Another major focus of this conference is the need for action on human rights, reflected in the conference slogan, ‘Rights Here, Right Now’. Action on HIV criminalisation; decriminalisation of homosexuality, sex work and drug use; and improved protections against discrimination for PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA. are the main areas of discussion.
“There can be no end to the pandemic unless we secure full protection of human rights for those most vulnerable to HIV,” Montaner told the crowd.
Strategies for a cure
The major scientific presentation to the opening ceremony was given by Australian researcher Professor Sharon Lewin, who addressed a subject rarely foregrounded at these meetings – the prospects for developing a permanent cure for HIV infection.
Lewin argued that a cure is still needed, due to the long-term challenge of maintaining an increasing population of PLHIV on treatments for life, and the medical challenges faced by people who take treatments long-term. Additionally, despite the amazing success of HIV drugs, people with HIV still have lower life expectancy than their HIV-negative peers, perhaps due to low-level viral activity and inflammatory responses. We should expect that people who have HIV have the same level of health and life expectancy as those who don’t, she said.
Finding a cure for HIV will require overcoming several barriers arising from the unique ways that HIV integrates itself into our bodies. Latently infected T-cells harbour HIV which can’t be reached by drugs, low-level viral replication continues to occur even with undetectable viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma., and HIV can hide in anatomical reservoirs, out of the reach of medications.
A cure for HIV could take the classical form of a ‘sterilising cure’ – this would mean the elimination of all HIV from the body – or, more likely, a so-called ‘functional cure’, akin to remission in cancer patients, in which the individual is able to maintain good long-term health without further treatment, but remains HIV-infected.
Lewin outlined a number of strategies and drugs being studied to try to eliminate HIV from latently-infected cells and biological reservoirs, either through T-cell activation (HDAC and methylation inhibitors), HIV geneThe most basic unit of genetic information. activation, or genetic therapy to make human cells resistantHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to HIV. These therapies are still in early development, but Lewin believes they have great promise and could re-open the case for an HIV cure within a few years.
“We hope this meeting will mark the beginning of a new search for an HIV cure,” she said.