June 28, 1998
Peter Piot, head of UNAIDS gave an impassioned talk in which he reviewed the progress and the disasters of the last two years. It may be posted on the Conference Web site (AIDS98.ch) and if so, is worth listening too.
The good news: Mortality rates in most developed countries are plummeting with modern therapy. Perinatal transmission rates are dropping, and now with short course AZT and agreements from Glaxo Wellcome and Bristol Myers to make their drugs available at a deep discount in developing countries, transmission to children should be preventable in many other parts of the world. Countries such as Thailand and Switzerland have had successful education programs that have decreased the number of new infections.
The bad news: The epidemic continues to be completely out of control. UNAIDS now estimates that 30 million people are infected worldwide - more than 90% live in developing countries. People there would be delighted to have lipodystrophy ("protease paunch") as an issue to worry about. India, Southeast Asia, and the former Soviet States are experiencing explosive outbreaks.
Some of the issues that will be debated at this conference will include whether we are doing the right things to move vaccines forward as fast as possible, how to use antiretrovirals in the developing world, and what that will do to the already scary problem of transmission of resistant viruses.