Track A report by Nilu Goonetilleke
session opened with Dr. Salim Abdool Karim presenting an insightful history of
the HIV pandemic since the first clinical descriptions of AIDS in the early 1980s,
highlighting the many milestones in HIV treatment and prevention achieved since
then. Admitting that, even with
these advances, “we will not be able to end AIDS tomorrow”, he discussed the
concept of ‘epidemic control’ – achieved when the basic reproductive ratio (R0)
falls below 1 - as the first step towards this goal. Importantly, he described
modelling analyses that suggested that epidemic control is achievable with existing treatment and prevention
strategies, even in regions with the highest HIV prevalence.
Ananworanich provided a clear and comprehensive overview of recent advances in
our understanding in the relatively new field of HIV cure. She suggested that
success will likely require combination approaches including early antiretroviral
treatment, followed by the use of anti-latency agents, the elimination of CCR5
positive cells via gene therapy/gene editing approaches, and the use of
immunotherapies to boost both humoral and T cell immunity. Importantly, she
commented that treatment interruption, which will be critical to testing and
developing future cure strategies, could be performed safely and ethically.
the words of plenary speaker Dr. Lydia Mungherera, Elizabeth Taylor Human Rights Award
winner Dr. Paul Semugoma and a moving video of Thai persons living with HIV-1,
were a powerful reminder that HIV-1 science cannot and should not exist
independent of HIV-1 advocacy, policy making and community engagement.
Track B report by Cristina Mussini
This session addressed new acquisitions in epidemiology, advocacy and
Salim S. Abdool Karim, South Africa: State
of the Art Epidemiology and Access. The epidemics has changed after 2005
with a decrease in mortality and in the number of new infections in adults and children;
TB is now a main problem. Two key factors impacted on epidemics: treatment as
prevention and increase resources for treatment and prevention. Microbicides
and oral antiretrovirals for prophylaxis are also important. We still have
several challenges: dysfunctional health systems: the importance of the cascade
of care: knowing HIV status, retention in care and adherence.
Lydia Mungherera, Uganda: People living with HIV at the centre of the HIV response. Medical
doctor living with HIV in Uganda. She left her work as clinician to do only
advocacy, being the only way to stop stigma. She underlined the female face of Africa
epidemics, importance of fighting for human rights, peer support for mother-to-child
transmission to increase adherence and engagement of fathers, and the role of
advocacy against discriminating laws. The role of people living with HIV is
fundamental also in research, to find new strategies to fight HIV, TB and
Jintanat Ananworanich, US: State of the Art HIV Cure: Where are we now and where are we going? The unique
case of Berlin patient proves that HIV cure is possible. However, in Boston patients the virus came back after 3
and 7 months, while the Mississippi baby remission phase lasted 2.5 years.
Immune system cannot eliminate all infected cells likely because of the viral reservoir,
whose size can be reduced by early treatments. Longer period of treatment,
vaccine (partially effective in macaques) or other strategies (such as shock
and kill, or induction of neutralizing antibodies) can prolong the period of
undetectable virus load.
Community report by Leonard Raymond Tooley
Where Are We Now?
Carol Kidu, Papua New Guinea
Jack Whitescarver, United States
session opened with a number of awards presentations:
three speakers urged the necessity to step up the pace, focusing on three different
areas of interventions. Dr Salim Abdool Karim gave an overview on the
development and introduction of a series of prevention tools and techniques that
have impacted the HIV epidemic over the years. Lydia Mungherera shared her
personal experience as positive woman and stressed the active engagement of
positive people’s communities in all decision making processes around
prevention, treatment and cure, with special reference to positive women’s role
as the epidemic is gender-specific and -sensitive. Jintanat Ananworanich’s
focus was cure and, based on her research, she envisioned that a combination
strategy including early treatment to reduce the reservoir followed by
reactivation of dormant state and then killing the remaining virus could be a
possible mechanism. She also identified social & ethical issues pertaining
to cure and voices of positive people’s and their expectation towards a cure.
State of the Art Epidemiology and
Karim, South Africa
showed how Global responses have succeeded in developing and implementing several
prevention tools and techniques; side-by-side mobilization of resources has made
a significant impact in bringing down HIV transmission globally. However in the
same breath he pointed out that interventions among the most at risk populations,
dysfunctional public health systems, stigma and discrimination, and legislative
obstacles are the major challenges of this era. He also commented that zero
transmissions is an aspirational vision: even getting to a point where HIV is
not a public health threat a long way to go.
People Living with HIV at the Centre
of the HIV Response
L. Mungherera, Uganda
Lydia, a positive woman and medical doctor, shared her personal experience and struggle
mobilizing a “Moms club” and discussed the difficult of mounting efforts to
mobilize positive people both – at National as well as regional levels - to address stigma, discrimination, and to
establish the rights of positive peoples’ participation and engagement in all
decision-making processes and program
implementation. She was emphatic in articulating the role of positive people,
with special reference to positive women, in prevention, treatment and care
programs and she stressed the need to step this mechanism up without delay.
of the Art HIV Cure: Where Are We Now and Where Are We Going?
on behalf of her team, shared finders on their research to bring about a possible
cure from HIV infection. While explaining technical interventions (which include
gene therapy to remove CCR5) she also raised social and ethical considerations from
community perspectives. She tried to reflect various challenges, particularly
the challenge with defining what a ‘cure’ means, determining what indicators to
measure. She also brought back the voices of positive people who are receiving
ART and how they respond to the issue of cure. A video clip of a number of participants
with their touching comments brought life to her presentation. ART recipients
spoke about their frustration in taking daily doses of medicine and their aspiration
to come back to ‘normal’ life, highlighting the level of stigma still attached
to positive people today.