20th International AIDS Conference - Melbourne, Australia


MOPL01 Where Are We Now?
  Plenary Session
Venue: Plenary 2
Time: 21.07.2014, 08:20 - 10:30
Co-Chairs: Epeli Nailatikau, Fiji
Carol Kidu, Papua New Guinea
Jack Whitescarver, United States

Webcast provided by International AIDS Society
08:20
MOPL0101
Red Ribbon Awards - announcement of winning organizations

08:22
MOPL0102
Award Presentation: Creative and Novel Ideas in HIV Research Grant Programme

08:30
MOPL0103
Elizabeth Taylor Human Rights Award presented by Michael Kirby

08:40
MOPL0104
Powerpoint
State of the Art Epidemiology and Access
S. Abdool Karim, South Africa

09:10
MOPL0105
People Living with HIV at the Centre of the HIV Response
L. Mungherera, Uganda

09:40
MOPL0106
Powerpoint
State of the Art HIV Cure: Where Are We Now and Where Are We Going?
J. Ananworanich, Thailand

Powerpoints presentations

State of the Art Epidemiology and Access - Salim Abdool Karim

State of the Art HIV Cure: Where Are We Now and Where Are We Going? - Jintanat Ananworanich
State of the Art HIV Cure: Where Are We Now and Where Are We Going? - Jintanat Ananworanich
State of the Art HIV Cure: Where Are We Now and Where Are We Going? - Jintanat Ananworanich
State of the Art HIV Cure: Where Are We Now and Where Are We Going? - Jintanat Ananworanich



Rapporteur reports

Track A report by Nilu Goonetilleke


This 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.

 

Dr. Jintanat 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.

 

Finally, 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 eradication.

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 malaria.

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


MOPL01:
Where Are We Now?

Co-Chairs:
Epeli Nailatikau, Fiji
Carol Kidu, Papua New Guinea
Jack Whitescarver, United States

Session Summary:

This session opened with a number of awards presentations:

All 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 Access
S. Abdool Karim, South Africa

Dr Salim 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

Ms 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.

State of the Art HIV Cure: Where Are We Now and Where Are We Going?
J. Ananworanich, Thailand

Jintanat, 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.




   

    The organizers reserve the right to amend the programme.