It was somewhat unnerving, in an understated way, that the IAS news was dominated by the launch of the WHO 2013 treatment guidelines, upstaging another WHO publication heralding that close to 10 million people in low- and middle-income countries are now on ART.
The anticipated level of interest for the launch was so underestimated that even after moving to a room double the original size of the first satellite meeting, it was still standing room only. 1,2 Our first reports cover these guidelines and some of their implications.
The tone and context for the rest of the conference was set by Steve Deeks in the opening plenary lecture: the benefits of ART for those with access to modern effective drugs dramatically extends life but residual inflammation on ART may be clinically relevant, especially in an ageing population. 3
After adjusting for all traditional risk factors, inflammatory biomarkers remain elevated during long-term ART and a single elevated biomarker (either IL-6 or d-dimer) predicts excess risk of morbidity or mortality ten years later. 4
Several other studies, including the VA database suggest that that HIV accounts for a 1.5-fold increased risk for cardiovascular events, 5 but as inflammation predicts a wide range of complications including frailty, lymphoma, type-2 diabetes, cognitive function and mortality in general population studies this is a caution that is the increasing focus of research.
The interventions that Deeks currently recommends (to us and to his patients) are simple: exercise to keep physically active and switch to a Mediterranean diet. To be healthy at 70 years old you need to start when you are 40 (though not suggesting it is ever too late).
Also, optimistically, the international and collaborative research efforts targeted to an HIV cure make this an increasingly tangible goal. The two-day pre-meeting to IAS 2013 on cure research highlighted a broad range of approaches including use of dendritic cells vaccines developed from a patients individual viral proteins and approaches to target viral latency including the panobinastat study currently running in Denmark. 6,7
We of course report much more paediatrics, pregnancy, PMTCT, new drugs, complications and transmission.
Many of the key oral presentations are available as webcasts, but unfortunately not all. Online coverage as we went to press is patchy and it is disappointing that many important sessions may not be posted online. Similarly, although many slide presentations are available, many are not.
However, all abstracts are online through the link to the Programme At a Glance online database for the meeting and contact details for many researchers are also available.
The year the conference has also posted webcasts from the press conferences on YouTube, including for the late-breaker sessions.
The following reports are included in this issue of HTB and more will follow next issue.