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AIDS 2006; Toronto, Canada; August 13-18, 2006

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The Body Covers: The XVI International AIDS Conference
XVI International AIDS Conference: An Interview With Dr. Myron Cohen

August 18, 2006

Dr. Myron Cohen is the J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology at the University of North Carolina (UNC) at Chapel Hill. He is Director of the UNC Division of Infectious Disease and UNC Center for Infectious Disease. His expertise is HIV prevention and its research. Dr. Cohen was interviewed by Bonnie Goldman on the final day of the conference.

Listen (2.7MB MP3, 7.5 min.)
This is Bonnie Goldman and I'm here at the International AIDS Conference with Dr. Myron Cohen from the University of North Carolina. He's the Director of the UNC Center for Infectious Disease. Dr. Cohen, tell me a little about what you think the take-home from this conference was.

I think what was most interesting to me is the title of the conference, which is "Time to Deliver." It kind of implied that a couple of years ago [when the theme of this conference was picked], people [were expected to now] be focused entirely on treatment and on the notion that access to care was critical and that new drugs and availability of drugs were critical.

In point of fact, the kind of herd that represented the conference was incredibly focused on prevention activities. Along those lines, it wasn't just any kind of prevention activity. Vaccines -- the V word -- [were] just about never mentioned. Other kind of alternative, avant garde, biomedical approaches, which may or may not pan out -- those were like the cat's meow at this conference, as manifested on the very first day by Bill and Melinda Gates committing themselves to oral pre-exposure prophylaxis and microbicides.

How did it this happen? Was somebody planning to get Melinda and Bill Gates and Bill Clinton to come here and to do this? Was this the intention of the conference? Because it certainly took over the public's perception of what was going on here.

No. I absolutely know that it wasn't planned. We've looked at a prevention field a long time and so you're kind of hearing the hoof beats behind you, running up. It was quite interesting. The Gates Foundation, of course, has in fact committed themselves to prevention. But their commitment probably affects the kind of overall perception ... of what's important. That's kind of Part A. Part B is there [are] not a lot of new drugs that are available. And this particular [group of] 31,000 people [who attended the conference], from all over the world; they in fact do have a more balanced perspective about their obligations, for both treatment and prevention.

What did you think of the treatment-related data that was presented? Like, for instance, today, there were a whole bunch of late breakers that everyone was talking about. Did you think it was interesting?

Yes. What was interesting, again, was how few treatment-related activities were discussed, and how absent a discussion of a vaccine was at this meeting. And the treatment regimens: this was kind of the realization of a pursuit of single-dose therapy with Kaletra, or drugs like Kaletra. Some other interesting data. But it wasn't a dominant theme.

What do you think of the ACTG 5142 study, the head-to-head study presented by Sharon Riddler, of Kaletra versus efavirenz? Did that make an impression on you? No one expected the results, that efavirenz would win.

Yes. I have the same kind of reaction, but I'm not sure this is a winning or a losing battle. At the end of the day, when these kinds of studies come out, it's impressed on me that it doesn't force the entire treating population to one kind of behavior. You know? And I suspect there's plenty of room for all these different regimens. I didn't see that the magnitude of the difference was such that it was a victory for one regimen and a defeat for another regimen, by any means. I also think that, from my point of view, as I heard the presentations related to kind of a starting on broader therapy and singling down to single-dose Kaletra; that's an interesting option.

The treatments have, and will, evolve over 25, 50, 100 years. This epidemic's not going away. So there will be an evolution.

What do you think of the new drugs like TMC125 and the Merck drug [integrase inhibitor MK-0518]? Are they going to change options for salvage patients?

It could, but I think, again, it's very premature. These are abstracts, you know, that are not in paper form, in a single observation, single sets of observations. It takes more than that to come to final conclusions.

So what do you think most physicians who attend this kind of conference come away with? What is the lesson that they learn, if any?

I think the number one lesson is that this is a global disease. The thing that's interesting is that there are very few meetings for 31,000 people. I just don't know. There's no specialty that has that many people -- maybe not even GI [gastrointestinal diseases]. And then the people at the meeting are so incredibly diverse and representing so many different constituencies. I think that the main thing that people get is how global and profound HIV, [and] the HIV epidemic is.

For me, personally; I learn a lot of stuff in the halls of things that are going on in the research fields I'm involved in.

Do you think it's worth it for a provider to come to this kind of conference? Because there's a lot of complaint that, oh, there's not that much treatment stuff, not that much science. But is it still worthwhile for someone?

Well, 31,000 people voted with their feet. And there were a lot of Americans included in that number. So I think it's worthwhile. I think you have to anticipate what you're going to get out of it, though. It's not ... for the absolutely committed treatment provider, it's not going to be comparable to CROI [Conference on Retroviruses and Opportunistic Infections] or ICAAC [Interscience Conference on Antimicrobial Agents and Chemotherapy]. And for the person who's a vaccine development person, you know, this is not the right meeting.

But I think for somebody interested in global relationships of HIV to the species, it's kind of unmissable.

So Dr. David Wohl was telling me that you don't actually attend that many sessions at the conference, that you have a lot of meetings in the hallway. Is that true?

We're making it about me ... I always oppose that, to talk about me. Well, David's not entirely telling the truth. I have a certain rhythm. Usually I go to the plenary sessions. Then I go to the science sessions because I think the people who have worked so hard on their oral sessions; those need to be attended better [in order] to demonstrate to people that what they've done all year or even more than a year, is important. So I just gravitate in a complete opposite direction. I actually learn quite a bit of how people are thinking, or at least younger people are thinking, about what they're doing, in terms of some of the immunity, or other things that are available to them.

The other thing: UNC [University of North Carolina] has programs in a lot of different countries. So this particular meeting is a chance for me to see all the people from all the countries we're working in. We have a biannual event with our school in China, Cameroon, Russia, Madagascar, especially in Malawi and the Congo. So that's fantastic for me. Because I can go to one place and see a lot of different faces and friends, and catch up. Then, as you point out, I tend to learn the most important things from people who I know, and I hear what they're doing. Not in abstract form; they kind of can't wait to tell me what their accomplishments [have been] over the preceding year. That's my most valuable source of information.

OK. Thank you very much for taking the time to talk with me.

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