Benefit of HIV Treatment as Prevention Underscores Need to Avert Treatment Disruptions and Expand Access to Reach Universal Targets

Cape Town, South Africa -- Researchers speaking in the first plenary session of the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) offered insights into current and future HIV prevention research and examined genetics and HIV-related inflammation as avenues for new treatments. The presentations, which also included data on the use of highly active antiretroviral therapy (HAART) for prevention and an update on strategies to reduce maternal transmission of HIV, reflect the breadth of expertise among the more than 5,000 researchers, clinicians and community leaders attending the conference, which runs from 19-22 July in Cape Town.

"The added preventive benefit of antiretroviral therapy represents a compelling new rationale for the re-invigoration of HIV treatment roll-out and gives further urgency to the need to avert disruptions in access to life-saving medicines," said IAS President Dr. Julio Montaner, who is IAS 2009 Chair and Director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada. "By reducing HIV transmission, as well as morbidity and mortality, treatment scale up is not only the right the thing to do for humanitarian and public health reasons; it is also a cost averting intervention, which makes fiscal sense in these difficult times."

"As we continue to expand access to antiretroviral therapy, it is crucial that we maintain a robust basic research agenda to learn more about how the virus interacts with and impacts the human body," said IAS 2009 Local Co-Chair Dr. Hoosen (Jerry) Coovadia who is Chairman of Dira Sengwe and Scientific Director of the Doris Duke Medical Research Institute at the University of KwaZulu-Natal in Durban. "We must remain relentless in our efforts to find avenues to treat HIV and ensure that proven and cost-effective strategies available to prevent maternal transmission are implemented broadly and available to women worldwide."

HAART as Prevention
In his plenary remarks, Dr. Reuben Granich, Medical Officer for HIV/TB in the HIV/AIDS Department of the World Health Organization (WHO), examined the significant promise of the use of HAART as part of a combined approach to HIV prevention that includes behavioral, structural and biomedical prevention interventions. Dr. Granich outlined the context and basic assumptions regarding this emerging strategy, including when to start ART for maximal clinical and prevention benefit. He also highlighted the essential roles of human rights, dignity and community engagement in the use of HAART for prevention and discussed the outstanding biological, feasibility, impact and cost issues related to research in this arena.

HIV and Host Genetics
Dr. Amalio Telenti discussed the relatively new field of HIV and host genetics, examining the role of host genetics in susceptibility to HIV-1 disease, plasma drug levels and treatment toxicity. Dr. Telenti, Professor of Medical Virology and Director of the Institute of Microbiology at the University Hospital Center of the University of Lausanne, Switzerland noted that despite some false starts, there is now solid data in this arena, including a thorough understanding of the role of common human genetic variation in HIV disease progression and drug toxicity. Dr. Telenti concluded by outlining the need for greater knowledge about the role of rare human genetic variation on susceptibility to infection and disease, and the translation of knowledge about host genetics into clinical tools.

Prevention of Mother-to-Child Transmission
Dr. Louise Kuhn called for a mobilization of political will to implement the latest knowledge on prevention of mother-to-child transmission (PMTCT), highlighting data on breakthroughs in PMTCT strategies during breastfeeding, including lactation support and counseling, continuation of maternal HAART after delivery, and extended infant prophylaxis with nevirapine. According to Dr. Kuhn, the urgency of implementing these interventions is underscored by accumulating data on negative impacts of avoiding or shortening the duration of breastfeeding. Dr. Kuhn also noted that despite the substantial progress implementing programmes using short antiretroviral regimens for PMTCT in sub-Saharan Africa, significant improvements in coverage and coordination between treatment and prevention programmes are needed for broader implementation. Dr. Kuhn is Associate Professor of Epidemiology in the Gertrude H. Sergievsky Center, College of Physicians and Surgeons at Columbia University and the Mailman School of Public Health.

Inflammation and HIV: A New Paradigm
Dr. Wafaa El-Sadr highlighted the unappreciated role of inflammation as an important cause of morbidity and mortality in people living with HIV. Inflammation has been noted to cause organ damage in people living with HIV, and biomarkers, particularly inflammatory markers, are associated with HIV disease progression, cardiac disease and mortality. Dr. El-Sadr reviewed the prominence that non-AIDS complications, including non-AIDS cancers and cardiac, renal, liver complications, have gained as a cause of morbidity and mortality as effective ART has dramatically decreased HIV-related morbidity and mortality. She also discussed the need for innovative interventions to control the HIV-associated inflammatory response. Dr. El Sadr is Director of the International Center for AIDS Care and Treatment Programs at the Columbia University Mailman School of Public Health, as well as Chief of the Division of Infectious Diseases at Harlem Hospital Center in New York City.