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CROI at 20: A Look Back

By Paul E. Sax, M.D.

February 28, 2013

The inimitable Carlos del Rio looks back at our premier scientific meeting, the annual Conference on Retroviruses and Opportunistic Infections (CROI), which starts this Sunday:

CROI, which started as a small national conference held in a hotel in Washington, D.C., will hold its 20th meeting this year. When CROI first took place, we had just returned from Berlin, and HIV scientists were frustrated because science was not making progress against AIDS. However, during the opening plenary, Robin Weiss of Chester Beatty Laboratories in London reminded us that AIDS would only be conquered though solid science.

How right he was -- CROI quickly became the forum where the best science was presented. Over the years we have learned at CROI about ART management going from single to double to triple therapy and about phase I, II and III studies of novel antiretrovirals such as ABT-378 (lopinavir), BMS-232632 (atazanavir), GW433908 (fosamprenavir), T20 (enfuvirtide), TMC125 (etravirine), TMC114 (darunavir), MK-0518 (raltegravir), GS-9137 (elvitegravir) and TMC278 (rilpivirine). Landmark ACTG and industry clinical trials and studies that have favored earlier initiation of ART -- first presented at CROI -- have resulted in modification of treatment guidelines. With HIV-infected persons now living longer, conditions such as lipodystrophy, cardiovascular diseases, and bone disorders have presented new challenges, and CROI has become more than a meeting of ID researchers.

While CROI initially had little international focus, the global epidemic is now a critical part of the conference. Results of important trials such as SAPiT and STRIDE have led to changes in national and international treatment guidelines. Prevention was not at first a major focus, but some of the most important biomedical prevention trials have subsequently been featured, with the result that the divide between prevention and treatment is now all but gone. Finally, at last year's CROI, first steps toward cure were presented, and the gloomy mood of early years has been replaced by one of cautious optimism that the epidemic can be ended. If -- or when -- that happens, we can be sure that good science was the cornerstone of such accomplishment.

In this table, I've highlighted what I think has been the major news from each year's conference.

Enjoy the trip down memory lane!

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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