5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention: summary of key research and implications for policy and practice – Clinical sciences

Mark Mascolinli,Rodney Kort

doi:10.1186/1758-2652-13-s1-s3

Abstract

Studies in several sub-Saharan African countries demonstrated that the expansion of antiretroviral therapy (ART) access is not only beneficial for people living with HIV, but also results in significant declines in tuberculosis and malaria incidence and prevalence, bolstering arguments for earlier and increased ART access and contributing to a growing understanding of co-epidemic dynamics. Several studies demonstrated that using standard triple-drug ART in resource-limited settings can reduce vertical transmission by as much as less than 1% if continued throughout breastfeeding.The Nevirapine Resistance Study (NEVEREST) results provided proof of concept that nevirapine could be used as part of a paediatric second-line regimen, despite exposure to nevirapine prophylaxis for vertical transmission, following successful suppression on a lopinavir/ritonavir-based regimen. A South African study found that high pre-treatment levels of inflammatory and coagulation markers were strong predictors of death, reflecting similar findings in high-income countries and reinforcing the shift towards viewing HIV as a chronic, inflammatory disease. An early study of a new integrase inhibitor (S/GSK1349572) indicated strong potency and limited cross-resistance with raltegravir, the only integrase inhibitor currently approved for treatment.

Highlights

Studies in several sub-Saharan African countries demonstrated that the expansion of antiretroviral therapy (ART) access is beneficial for people living with HIV, and results in significant declines in tuberculosis and malaria incidence and prevalence, bolstering arguments for earlier and increased ART access and contributing to a growing understanding of co-epidemic dynamics
Salient studies detailed the effect of triple-drug ART on co-epidemic tuberculosis (TB) and malaria and on prevention of vertical transmission
Current national and international guidelines for children exposed to single-dose nevirapine (sdNVP) call for a first-line regimen including the protease inhibitors (PIs), lopinavir/ ritonavir, because infants infected despite sdNVP often have virus resistant to the non-nucleosides, nevirapine and efavirenz

Summary

Discussion

Advances reported in clinical research at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2009) could have a profound impact on global and national policies guiding antiretroviral initiation. Current national and international guidelines for children exposed to sdNVP call for a first-line regimen including the protease inhibitors (PIs), lopinavir/ ritonavir, because infants infected despite sdNVP often have virus resistant to the non-nucleosides, nevirapine and efavirenz. A study of 5484 children under 16 years old starting their first ART in sub-Saharan Africa found that only 11.4% met virologic failure criteria (consecutive viral loads above 10,000 copies/mL) more than five months after beginning treatment (Figure 2) [9]. Matching each person who died (cases) with two people who did not die (controls) by date of randomization, follow-up time, study site and CD4 count, Ledwaba found significantly higher pretreatment levels of two inflammation markers (C-reactive protein and interleukin-6) and one coagulation marker (D-dimer) in cases. A double-blind trial enrolled 35 HIV-positive adults with a viral load above 5000 copies/mL, no integrase inhibitor experience, and no ART for the past 12 weeks. Other studies reported at the conference demonstrated limited cross-resistance between S/GSK1349572 and raltegravir, the only marketed integrase inhibitor [13,14]

Findings

Conclusions

Tebas P