When in Rome

The 6th IAS Pathogenesis Conference doesn’t really end after the closing session
by David Miller

The panel on Controversies in HIV Cure Research sits beneath a photo of Timothy Brown, aka the Berlin Patient. Photo © IAS/Steve Forrest/Worker's Photos
In 1987 I attended my first AIDS conference, beginning twenty-four years of treatment activism and conference attendance. Now having attended over 200 HIV-specific and related conferences, it is evident to me that each conference offers a series of advances that bring us closer to seeing the end of the AIDS crisis. The world’s largest open scientific conference on HIV/AIDS—the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2011) held in Rome, Italy, in July 2011, was no exception to previous experiences, showing an overwhelming amount of data on the widest range of issues in AIDS research, treatment, and care.

Getting myself to Rome and reporting on the conference was as much of a challenge as devouring the enormous amount of research shown. We could spend months reporting on all the innovative advances presented at IAS 2011 and, in a number of venues, much of this vital knowledge has and will be appearing in the HIV media, both on the Web and in print, for months to come.

The sifting out of hundreds of presentations to identify the most compelling issues that, as a community, we need to pay attention to, requires some insight into how advances in research will translate to changes in treatment. In four days, conference attendees were drowned by fifty sessions, nine plenaries, 3,552 abstracts, and thirty-one satellite meetings.

The 6th IAS Pathogenesis Conference was important enough that Rep. Alcee Hastings (D.-FL) issued House Resolution 360 on the conference, which noted the dangers we’re facing from emerging drug resistance, including the spread of XDR TB (extensively drug resistant tuberculosis). This resolution is a clear sign that some of our more intelligent, responsible legislators are paying closer attention to the translation of the science that can help end this plague.

One shuddering event, just days before the conference, was the announcement that the Italian government has no plans to continue the National AIDS Research Program at the Istituto Superiore di Sanità (ISS), the equivalent of the U.S. National Institutes of Health that, at its peak in the 1990s, received €25 million a year. Italy is the only G8 country that has not recently contributed to the Global Fund to Fight AIDS, Tuberculosis and Malaria. A lot of very important research is going to be lost, research we all need now.

How fast can you run?
On Saturday, July 16, a session called “The New Concepts in HIV Immunopathogenesis, Treatment and Vaccines” drew key international opinion leaders who presented their innovative views and stimulated debate to help advance four critical areas of research in HIV infection: immunopathogenesis, new concepts in vaccine strategies, eradication of virus reservoirs, and molecular mechanisms of viral control. The meeting prompted serious discussion between prominent vaccine and treatment specialists and basic scientists, providing a unique opportunity to cross-fertilize these different fields.

The SHE (Strong, HIV positive, Empowered Women) Programme European Launch spoke to how much patient advocates, despite our reduced numbers, are still very influential in driving the clinical agendas in our interests.

Another important event at IAS Pathogenesis was the launch of a community based study of women living with HIV/AIDS in Europe. The SHE (Strong, HIV positive, Empowered Women) program is developed and steered by an independent advisory board, comprising advocates, women living with HIV, and other HIV healthcare experts composed of forty women representing close to forty advocacy groups from across eight European countries including Belgium, France, Germany, Italy, Poland, Portugal, Spain, and the United Kingdom. The program provides support to women living with HIV, aiding them to empower themselves to improve the quality of their lives, including getting the most out of their healthcare services and to create an effective dialogue with healthcare professionals. This will be a groundbreaking study of the challenges that HIV-positive women in Europe are facing; it addresses the clinical disparities between clinical outcomes we see between men and women and aims to engage policymakers to consider the special issues confronting women living with HIV, thereby increasing awareness and understanding throughout Europe. The SHE programme is developed at the discretion of the faculty and is funded by Bristol-Myers Squibb.

Another incredibly important meeting, “Towards an HIV Cure” Global Scientific Strategy–International Working Group & Stakeholders’ Advisory Board meeting, was

UNAIDS Executive Director Michel Sidibé at the Opening Session of the conference. Photo © IAS/Marcus Rose/Workers' Photos
held on Thursday, July 21. Following the success of the workshop “Towards a Cure: HIV Reservoirs and Strategies to Control Them,” held in conjunction with the XVIII International AIDS Conference (AIDS 2010) in Vienna in July 2010, IAS decided to continue to mobilize the scientific community and guide the development of a Global Scientific Strategy Towards an HIV Cure. An international scientific working group is developing a draft global scientific strategy in cooperation with a stakeholders’ advisory board. Those two groups will meet after IAS 2011 to define research priorities in the field of HIV cure research. You can find a full list of the stakeholders membership on-line at: www.iasociety.org.

The Fourth International Meeting on HIV Infection and the Central Nervous System–Treating the Brain in the HAART Era took the opportunity of so many HIV clinicians and scientists gathered together in Rome to bring the issues of neurological manifestations, including HIV-dementia to the forefront of the discussions. Among the most threatening complications of HIV infection, although the incidence of neurocognitive impairment associated with HIV brain infection and progressive multifocal leukoencephalopathy has dramatically decreased among people receiving combination antiretroviral treatments, these complications are among the most frequent and devastating complications of HIV currently observed.

Despite significant progress in understanding the pathogenesis of these complications and efforts to translate this knowledge into clinical practice, it was made clear at the meeting that optimal management tools in HIV neurology are still lacking. At this meeting, attendees began to address unsolved issues, discuss clinical strategies and the need to begin to examine studies and interventions PLWHA’s currently have available.

Part of my work at the conference was helping to put on the NAPWA Treatment Horizons: Pathways Towards a Functional Cure satellite symposium, which was produced in conjunction with staff from Health People, an AIDS service organization located in the South Bronx, the epicenter of the epidemic in North America and one of the poorest communities in the U.S. The satellite symposium showed data on therapeutic vaccines, gene therapy, new antiretrovirals in development, and advances in treatment that are backed by good clinical rationale and experience. Close to a dozen new developments in clinical research to change the course of the epidemic included:

• Sandy Pijaia, MD, presenting on TBR652, a Phase II chemokine antagonist and Julian Chick’s presentation on Avexa’s long-awaited third-generation nuke, ATC.
• Another very promising antiviral maturing in development, ATC, a Phase III NRTI, was presented by Susan Cox, PhD, at Avexa.
• Virxsys presented on VRX 496, a gene therapy in Phase II clinical development, Vacc4x, a therapeutic vaccine in Phase II being developed by Bionor Pharma along with FIT-06 (FIT Biotech), which is also in Phase II development.
• Aphios presented data on APH-0812, a therapy for treating HIV latency, a new approach involving histone deacetylases (HDACs) inhibitors and non-tumor promoter Protein Kinase C (PKC) agonists.

Demonstrators protest Italy’s non-payment into the Global Fund. Photo © IAS/Marcus Rose/Workers' Photos
Gary Blick, MD, who heads World Health Clinicians, a nonprofit, presented on MuscleGel, a new whey protein supplement that is getting support for Medicaid approval from a number of advocacy groups because of its ease of use. BioK+, the makers of CL1285, a probiotic, joined in on a presentation on therapeutic nutritional supplements that are so often overlooked. Both protein supplementation and probiotics are very helpful in managing side effects of ARVs and can help with HIV-infection-related weight loss, which is supported by a lot of data.

Disappointing was the lack of new data on the viral decay accelerator from Koronus or Adaptimmune, Argos Therapeutics’ autologous cell therapy and the research from Mike McGrath, MD, at Pathologica. Again, we can presume the financial climate is having an impact on very promising research that can save our lives.

The trends in HIV research in this stunningly unstable economy are greatly affecting the continued future of important research that is critical for the future of further advances to end the AIDS pandemic. We’ve all seen how therapeutic success has driven research of a cure closer to reality but more basic understanding of how to control HIV has to become better focused and translate into studies. HIV vaccines continue to remain out of reach, but it’s clear that groundbreaking ideas are coming forward into further investigation that could also contribute to curing HIV.

So what do we do now?
• Join International Treatment Preparedness Coalition (ITPC), ATAC and other organizations, both global and local, to get ready for the 2012 Conference on Retroviruses and Opportunistic Infections (CROI 2012) and the upcoming HIV Persistence Workshop in St. Maarten, West Indies, from December 6–9, 2011.
• Join other AIDS treatment activists and continue to learn more and report on scientific and clinical advances presented on the IAS Pathogenesis Conference Web site. There’s so much more research that demands more of our attention.
• Tell our legislators to find support for new strategies that may lead to advancing our understanding of how HIV works.
• Have a great idea? Know a clinician who does? Check out the new program at the NIH at: www.cnihr.org, which sponsored an instructive meeting on grant application programs focused on HIV eradication.

As we watch the horn of Africa experience a very unnoticed apocalypse, while our national economy has begun to resemble the convolutions affecting much of Europe, it is important for people with HIV/AIDS to defend our hard-won gains, to increase our knowledge about what’s in the pipeline, and to advance the research that may save our own lives, as we see from the first actual cure that HIV can be wholly defeated. A cure seems just within reach. The question now is how far we can all extend ourselves.

David Miller is a member and former co-chair of Cornell ACTG Community Advisory Board, as well as a member of the Campaign to End AIDS, The AIDS Treatment Activist Coalition and GNP+, the Bronx HIV/AIDS Advocacy Network and a board member of The AIDS Institute. David works with NAPWA and the Health People HIV/AIDS Treatment/Policy Education Advocacy Demonstration Project in the Bronx. David was a member of ACT UP NY.

September 2011