This year’s meeting was held from July 19-22nd in Vancouver, British Columbia, Canada.
The highlight of the conference was the early treatment trial named START Study (Strategic Timing of Antiretroviral Therapy) which was published in the New England Journal of Medicine at the time of the conference. This study was terminated prematurely because the data showed that HIV infected patients who are treated early (CD4 > 500) in the course of infection have a better outcome compared to those who start treatment when CD4 counts are < 350 cells/uL. The benefits of early treatment outweigh the attendant risks.
It is expected that the data from this study will be crucial in determining the direction of WHO guidelines for HIV therapy. The updated guidelines is expected to be released at the end of this year. Based on the level of evidence (Class 1A), there is unequivocal evidence to support early initiation of ART (antiretroviral therapy) in all HIV infected patients at the time of diagnosis.
The conference also covered other themes :
- Adoption of UNAIDS 90-90-90 goal by 2020. This targets achieving 90% of all infected with HIV knowing their status, getting 90% linked to care and achieving viral suppression in 90% of those receiving care
- Advances in PrEP (Pre-exposure Prophylaxis). Various new trials were presented on the efficacy of PrEP regimens. Of interest was a study in MSM (men who have sex with men) on a real world, on demand PrEP using 4 pills (Truvada) starting with 2 pills prior to exposure and follow-up with one pill 24 hours and another 48 hours after exposure, which showed 86% protection.
- Update on cure strategies were also discussed. Research into the development of cure in HIV have now been translated into clinical trials using gene therapy and stem cell transplantation studies involving CCR5 knockout cells.
- Update on vaccine trials. Besides efforts in developing a preventive vaccine, other groups have proposed that a therapeutic vaccine may be more realistic. Due to the complexities of the virus and the incompletely understood biology, a vaccine will be part of a multi-prong approach to eradication/ remission and long term control of the disease.
- With the advent of highly effective anti-HCV (Hepatitis C) drugs, co-infections in HIV-HCV, HIV/HBV, HIV/HCV/HBV have much improved outcomes. There was also an update on HIV/TB co-infection and the results of the TEMPRANO study was presented. The data highlighted the benefit of early TB prophylaxis with Isoniazid in a highly endemic population. Together with anti-retroviral therapy, isoniazid prophylaxis resulted in much better outcom6.
- Finally, the meeting also honoured the victims of the Malaysian Airlines tragedy which was shot down in Ukraine claiming the lives of 268 people including 6 participants to the 20th International Aids conference in Melbourne 1 year ago. A special memorial and a 30 minutes lecture series was dedicated to the prominent AIDS researcher Prof Joep Lange who perished in this tragedy.
All in all, it was a very fruitful meeting and a very enriching scientific experience.