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This article was provided by Seattle Treatment Education Project.
 

  
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  • Glossary Glossary

6th Conference on Retroviruses and Opportunistic Infections (CROI)

Light at the End of the Tunnel?

Overview

Web Access to Conference Information

Access to most of the information presented at the CROI is available from the conference's own excellent web site: www.retroconference.org. Many of the lectures can be heard on that site, and the slide shows can also be viewed. All of the abstracts from the CROI are available on their web site, and can be searched as well. Additionally, for the first time ever, the CROI has published all of the posters on their web site.

Other excellent sites are the HealthCG site (now owned by Medscape) at www.healthcg.com and hiv.medscape.com/conferences/retro99/, which has extensive daily reports written by prominent HIV specialists. Another good web site with conference information in the National AIDS Treatment Advocacy Project, at www.natap.org.

More than 3,500 people gathered in Chicago from January 31 through February 4, 1999, for the 6th Conference on Retroviruses and Opportunistic Infections (CROI). This conference began in 1994 as a small meeting for basic scientists studying the HIV virus and clinicians treating people with HIV. It is now one of the most important annual HIV gatherings, attracting virologists, immunologists, HIV community treatment activists, community press, and clinicians treating people with HIV.

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The general media gave the greatest coverage to the presentation that convincingly demonstrated that HIV originated in monkeys and has been transferred to humans at least three times. However, the most clinically relevant and important presentations at the 6th CROI were those that hinted that HIV might be controlled with a combination of highly active antiretroviral therapy (HAART) and stimulation of the immune response to fight HIV. There is very real hope that someday, after suppression of viral replication and boosting of the immune system's response to HIV, patients will be able to stop HAART. Eradication might not be necessary -- only containment of the virus, as occurs with herpes, cytomegalovirus (CMV), and several other viral infections.

Information about a number of intriguing issues was also presented at the 6th CROI:

  • Drug-resistant new HIV infections are becoming more common, and are now seen in 10 to 15 percent of all people.

  • Many people lack resistance to PIs at time of failure of regimens containing two nucleoside reverse transcriptase inhibitors (nRTIs) and a PI

  • There appears to be a decreased risk of transmitting HIV while on HAART if HIV RNA numbers are low.

  • There is continued excellent data on the use of efavirenz as an alternative to a PI regimen with up to 48 weeks of followup.

  • Studies are showing impressive immune reconstitution, including new CD4 and CD8 cells capable of responding to new infections, even in people who begin HAART with very low numbers of CD4 cells.

  • There is good recovery of pathogen-specific immunity to pneumocystis pneumonia (PCP), cytomegalovirus (CMV), and mycobacterium avium complex (MAC) in most people on HAART. It appears safe to stop PCP preventatives on HAART after 3 to 6 months if the CD4 count stays above 200 and the viral load (HIV RNA) is low.

  • Lipodystrophy studies on men and women show these fat deposits to be a very significant problem for most people on PI therapy. The first few trials of switching to a non-PI drug to treat lipodystrophy were presented, as well as a few other novel approaches to treating lipodystrophy with other drugs.

  • New approaches to improving HIV-specific immunity and/or eradicating the residual population of HIV-infected cells after HAART include immune stimulants such as interleukin 2, and the isolation of HIV-specific immune cells (cytotoxic lymphocytes, or CD8 cells) expansion in the lab with re-infusion of many of these cells.


Index of STEP Conference Summaries

Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.
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