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Will CROI 2010 Provide HIV/AIDS Clinicians With More Questions Than Answers?
A Blog Entry From CROI 2010

By Myles Helfand

Feb. 16, 2010; 4:49 p.m. Pacific Time

Myles Helfand

Myles Helfand, Editorial Director

CROI 2010, one of the world's premiere HIV research conferences, is underway here in San Francisco. About 4,000 of the brightest minds in HIV/AIDS have descended on the sprawling Moscone Center to drink in the results of more than 1,000 breaking studies and engage in detailed discussions on a massive range of issues.

The large scale of this conference, not to mention the staggering diversity of its presentations, make it a considerable challenge for any organization to cover. But over the days to come, we'll do our best to provide those of you who couldn't attend this conference with a pretty solid sense of its highlights.

Of course, what constitutes a "highlight" to one person may be an afterthought to another. By necessity (we may be a huge site, but we have a tiny staff) and due to the interests of most of you who read this site, we're going to skew our coverage toward the studies that are most likely to be relevant to HIV care providers in the U.S. For instance, there's plenty of interesting data coming up on the antiretroviral therapy front:

And I'm only touching on a few of the many antiretroviral therapy studies that may herald changes in treatment strategies or the future arrival of a new generation of effective drugs -- despite the fact that the drug pipeline does indeed seem a bit drier than it has been in some time.

Meanwhile, the "real" story, at least from the standpoint of many practicing clinicians, may not be all these juicy tidbits on antiretroviral therapy, but rather on the increasingly complex story that your own patients are likely already telling you -- or, more to the point, that your patients' bodies are likely telling you. Researchers are becoming increasingly aware of a "new generation" of complications, I suppose you could call it, that appear to be occurring more frequently, and with an earlier onset, in HIV-infected people irrespective of their level of treatment experience: cancers, bone problems, inflammation, cardiovascular disease, liver and kidney disorders. Coming into this conference, many of these complications provided more questions than answers -- so many more, in fact, that we don't even know what to call them as a group. Are these truly "aging-related" complications accelerated by HIV (or potentially long-term HAART), or do we need to think about them differently? Will CROI bring us closer to an understanding of why these problems emerge, and what we can do to prevent or treat them?

And amidst the flurry of potential developments on the treatment and complication fronts, there's a huge shadow hanging over this epidemic for those who care for people with HIV in the U.S., as well as those who work tirelessly in HIV prevention and education: HIV/AIDS is not going away. Annual incidence isn't dropping. Despite almost 30 years, despite all of the deaths, all of the fear, all of the efforts made by heroic individuals and groups to educate communities and get more people tested, the HIV/AIDS epidemic is not currently on the decline in the U.S., particularly among African Americans and men who have sex with men. It's as though the lessons of the 1980s and 1990s have been abandoned, relegated to the past and thrown away as no longer relevant. The urgency of HIV/AIDS in the U.S. is long gone, yet tens of thousands are infected each year, many of whom may not find out until it's nearly too late.

This conference is liberally peppered with presentations exploring new methods for HIV prevention, including antiretroviral-laced microbicides, the concept of universal testing and treatment, the ever-elusive search for a vaccine, and any number of intervention strategies. Taken individually, each presenter seems to have The Answer. But taken as a whole, this conference can easily seem like a Tower of Babel populated by people who are searching, hoping, for a solution that has yet to present itself.

In fact, part of me can't help but wonder whether that chaos will end up being a defining feature of this year's CROI. I hope I'm wrong; I hope the world's top HIV/AIDS researchers and clinicians will leave here with new, encouraging answers to some of the questions that most vex the U.S. and global communities, and with clear directions forward. But similar to how 2009, in the words of the eloquent David Wohl, M.D., "stunk" for the clinical HIV community, it feels like we enter CROI 2010 with a glut of disturbing mysteries to solve and not much sense for how that will happen.

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