The XVIII International AIDS conference in Vienna closed today after positive reports during the week on the first partially effective ARV-based microbicide, progress on male circumcision, promising results on new antiretroviral treatments and some reports of lower incidence around the world.
But the funding of treatment remains a concern, and delegates at the conference launched what they called “Treatment 2.0″ – an effort to make AIDS money go further given donor cuts.
Dr Julio Montaner, AIDS 2010 Chair, President of the International AIDS Society said: “Billions of people stand in solidarity with us in our drive for universal access.
“We must rally their support behind Michel Sidibé’s Prevention Revolution and Treatment 2.0 initiative and UNAIDS to ensure that world leaders do not turn their backs on their pledge to reach the goal of universal access.”
Professor Nicoli Nattrass, Director of the AIDS and Society Research Unit at the University of Cape Town told the Ecumenical Advocacy Alliance: “The days of the big numbers are gone. Treatment 2.0 means doing more with what we’ve got.”
Another rallying point at the conference was around better rights and evidence-based programmes for injecting drug users.
By today 12725 people had signed the Vienna Declaration, the official declaration of the conference, calling for “more rational and scientifically sound drug policies to strengthen HIV prevention for people who use drugs”.
AIDS 2010 attracted 19,300 participants from 193 countries with 248 sessions covering science, community and leadership on the agenda.
The XIX International AIDS Conference will be held in Washington, DC, in the US in July 2012.
They are at the forefront of the HIV epidemic in Eastern Europe and Central Asia.
The researchers recommend improved access to opioid substitution therapy such as methadone.
This strategy could help IDUs to stay on antiretroviral treatment and help to prevent new infections, they say.
“Offering Opioid Substitution Therapy (OST), such as methadone or buprenorphine, significantly decreases HIV acquisition and transmission and increases the chances of HIV positive people who inject drugs taking up and staying on highly active anti retroviral therapy (HAART),” said Professor Dr Charles O’Brien.
A researcher from the University of Pennsylvania and co-author, he says: “This in turn can lead to reductions in the community viral load and decrease new infections.”
The authors call for expanded access to highly-active antiretroviral treatment (HAART) among “high-risk, hard-to-reach drug using populations”.
“The scientific evidence is in, individuals with and without a history of injection drug use derive similar survival benefit from HAART. There is an urgent need to treat drug users, not abuse them as much of the current drug policies do,” said Dr Julio Montaner, President of the International AIDS Society.
The report emphasises how needle exchange programmes have been proven to prevent HIV spreading among IDUs.
“The report outlines how programs can increase this effectiveness by scaling up a comprehensive package of harm reduction interventions,” the IAS media centre states.
“The selection of Vienna as the host city of the XVIII International AIDS Conference reflects the role the city has played in bridging Eastern and Western Europe. During the past week there has been a strong focus on Eastern Europe and Central Asia region, now home to what is the fastest growing HIV/AIDS epidemic in the world.”
Injecting drug use is driving this increase. For example, about 65 per cent of HIV infections in Russia for instance, are through injecting drug use.
Montaner says: “We’ve been witness this week in Vienna to what is an all too familiar story: the unacceptable criminalisation and stigmatisation of a group of people, in this case, people who inject drugs. As a result …people who inject drugs are now shouldering the burden of an HIV epidemic that shows all the signs of moving into the wider community.
“On the other hand we’ve also heard success stories in the region.”
* When it comes to another kind of drugs – new antiretrovirals – nam/aidsmap reports good news on TBR-652 and inflammation in their Vienna conference update today
The “test-and-treat” strategy to stop HIV/AIDS – providing universal access to treatment to reduce new infections – seems to be gaining momentum at the XVIII International AIDS Conference in Vienna.
“Treatment as prevention is a promising strategy that needs to be properly evaluated in clinical trials,” Dr. Bernard Hirschel of the Infectious Diseases Service Geneva University Hospitals in Switzerland, said at the plenary talk today.
It is known that decreased viral load lowers the risk of HIV transmission and that effective treatment lowers viral load to undetectable levels, he said.
Therefore, if one could identify and treat all people living with HIV/AIDS, the epidemic would wither and die away, Hirschel said.
But he admitted this was a “pipe dream” and called for clinical trials to be set up to test the preventive potential of ART.
The “test-and-treat approach is unlikely to be scaled up without clear evidence that it works, he indicated.
Researchers from France and South Africa intend to test “everyone in at least 30 South African regions” in a five-year study starting this year, according to a report by Bloomberg.
“In half the regions, they’ll start treatment immediately for those who test positive. In the other half, they’ll wait until the patients’ immune systems deteriorate to a certain level,” Bloomberg reports, quoting Hirschel.
New infections have fallen in some cities as treatment expands, some studies have shown, including results from Canada in the Lancet this week.
Moreover research on transmission risks in couples where one partner is HIV-positive and the other HIV-negative, known as sero-discordant couples, suggests that treatment protects against infection.
“Funding agencies are currently evaluating proposals for more definitive studies, where a number of communities are randomized to receive the “test-and-treat” approach, or continue as before,” the IAS conference media centre reports.
Meanwhile, international agencies at the conference warn that donor funding for antiretrovirals may be running short.
Michel Kazatchkine of the Global Fund to Fight AIDS, TB and Malaria said donations from European countries to the fund dropped in 2008-2009 by $600 million, and the fund has an estimated shortfall of $4 billion to $6bn.
The gel offers moderate protection to women against HIV – reducing a woman’s risk of getting HIV during sex by 39%.
But among women with high adherence (80% or more) the efficacy was 54%.
It also provided 51% protection against genital herpes infections.
This is the first tool of HIV prevention that is within the control of women.
This is also the first positive result from a microbicide trial, after 11 trials testing six candidates in the past showed no effect.
It’s a day to celebrate since the results show prevention research is moving in the right direction.
Principal investigators, Dr Quarraisha Abdool Karim, Professor Salim Abdool Karim, their team and the 889 female volunteers, have given the microbicide field a major boost.
But the study, which is a proof of concept trial, needs to be repeated to scale to get independent confirmation of these results.
They are being presented at 1pm today at the XVIII International AIDS Conference in Vienna, Austria by the Centre for the AIDS Programme of Research in South Africa (CAPRISA).
Injecting drug users are not the only focus of the AIDS Conference in Vienna next week.
One of the priorities for African delegates will be the release of the results of the CAPRISA 004 microbicide trial next Tuesday, 20 July at 1pm.
This randomised controlled trial in South Africa tested the safety and efficacy of a 1% tenofovir-gel candidate, the first to use an antiretroviral to block infection.
The gel was tested among some 900 volunteers in CAPRISA’s rural Vulindlela site and urban Thekwini site.
Scientists and activists – particularly in the field of HIV prevention – are waiting in suspense to find out if this gel works.
None of the six candidates tested in 11 trials over the past 15 years has been successful yet.
The Global Campaign for Microbicides and Treatment Action Campaign have already organised a satellite session at the conference on the implications of the outcome.
The spread of HIV among injecting drug users across Europe – outside of sub-Saharan Africa one in three new cases of HIV area among users – will be high on the agenda at the International AIDS Conference in Vienna, Austria, which starts on Sunday.
In Eastern Europe and Central Asia, injecting drug use is the “primary cause” of the rapid spread of new infections.
Ahead of the 18th AIDS meeting, experts from across the world have released the “Vienna Declaration” calling on governments and the UN to promote rational drug policies that promote human rights and public health.
“As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime,” they stated, warning that the criminalisation of illicit drug users fuels HIV.
Yesterday three former Latin American presidents from Brazil, Mexico and Columbia yesterday signed the declaration, along with Brazilian writer Paulo Coelho, Peruvian writer Mario Vargas Llosa and Nicaraguan writer Sergio Ramírez.
“The war on drugs has failed,” said former Brazilian president Fernando Henrique Cardoso.
“In Latin America, the only outcome of prohibition is to shift areas of cultivation and drug cartels from one country to another, with no reduction in the violence and corruption generated by the drug trade.”
AIDS 2010 Chair Dr. Julio Montaner, president of the International AIDS Society (IAS), said: “I hope that the Vienna Declaration will inspire many more political leaders to cast aside the drug war rhetoric and embrace evidence-based policies that can meaningfully improve community health and safety.”
The International AIDS Society, the International Centre for Science in Drug Policy, and the BC Centre for Excellence in HIV/AIDS initiated the declaration.