Coverage of 2007 IAS
(International AIDS Society)

July 2007, Sydney, Australia

Day One: Morning Plenaries and Other News

July 23, 2007

Five thousand doctors, researchers, activists and people living with HIV are gathered in Sydney, Australia for the 4th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Project Inform will provide regular updates on the most interesting and important developments presented here.

The conference officially kicked off last night with the opening ceremonies. This followed a day full of satellite meetings ranging from pharmaceutically sponsored updates to community focused briefings. The general theme of the meeting was summed up by Anthony Fauci’s talk, titled “Much Accomplished, Much to Do.”

The first morning plenary covered three disparate topics. The first address, given by Dr. Debrework Zewdie, detailed both the necessity and challenges of performing research alongside the rollout of anti-retroviral therapy in the developing world. She reminded the audience that only a few short years ago the discussion of bringing these life-saving medicines to developing countries revolved around the presumed inability of the health infrastructures in these areas to handle the burden of anti-HIV therapies, and the fears of a resulting spread of drug-resistant HIV throughout the world. As resources have become available and drugs introduced into some of the hardest hit areas, these fears have proved overstated, if not unfounded. Dr. Zewdie argued for research to ensure that treatment paradigms are evidence based and cost effective.

Shifting gears, Michael Lederman talked about the role of immune activation in HIV disease. He proposed a model of HIV disease where persistent immune activity, fueled both directly and indirectly by HIV, is the bedrock of the immune system decline that is the hallmark of the disease. For many years, the basic model of how HIV causes disease, called pathogenesis¬, has focused on HIV infecting and destroying CD4 T cells. A growing body of research—some reviewed by Dr. Lederman—has suggested this model to be oversimplified at best. Rather that seeing HIV disease simply as a disease of a weakened immune system—which it certainly is, many immunologists are focusing on over-activation of the immune system as the underlying factor leading to immune system decline.

The final, and undoubtedly funniest presentation, was Dr. Brian Gazzard’s on HIV and aging. Citing data from the United Kingdom where around 1/3 of people living with HIV are over 50 years old, Dr. Gazzard spoke of the challenges an aging population of people with HIV pose. He focused on what he termed the ‘Geriatric Giants’ of cancer, heart disease and dementia. He detailed how one of the key features of HIV diseases is how it accelerates many of the processes associated with aging. This leads to higher rates of older-age associated diseases occurring earlier in people with HIV.

Two pharmaceutical companies are making news already, but not for any important new data. Abbott announced that it is dropping its lawsuit against ACT UP Paris. The dispute revolved around Abbott’s inability to successfully negotiate with the government of Thailand. The economic and political issues involved in this dispute are complex, but Abbott’s decision to drop the complaint against ACT UP Paris is welcome.

Roche is getting some unwanted attention over its recent recall of the protease inhibitor, Viracpet (see Manufacturer Recalls Viracept). Representatives from the company met with community members here in Sydney and reportedly promised to take various actions—from paying for any costs associated with people needing to switch regimens to holding public meetings on what some are calling a debacle. Roche manufactures Viracept in much of the world, but not in the US, where Pfizer both manufactures and sells the drug. The recall did not affect the US.