Abstract
The question of whether to initiate ART at higher CD4+ cell counts than currently recommended by World Health Organization (WHO) treatment guidelines received much attention at the XVII International AIDS Conference (AIDS 2008). If studies presented at the conference ultimately lead to a revision of WHO treatment guidance, the estimated number of people who will need ART globally will increase substantially. Task-shifting is emerging as an important strategy for dealing with the acute shortage of health care workers in many high-burden countries, and several studies presented at AIDS 2008 demonstrated the impressive health system efficiencies garnered by using nurses or other health care providers to deliver HIV care and treatment. Other key presentations and discussion at the conference focused on the optimal time to start TB treatment in HIV-infected patients, the growing risk of resistance in high-burden countries, including its impact on future treatment options, and several large cohort trials testing optimal drug regimens in resource-limited settings.Biomedical prevention research continues to confirm the long-term, protective benefits of circumcision. Several studies involving HIV serodiscordant heterosexual couples have produced data suggesting a strong protective effect of ART for HIV-negative partners. Disappointing results from recent vaccine and non-ARV based microbicides trials are nevertheless providing important data to this field, and the expanding number of pre-exposure prophylaxis (PrEP) trials and ARV-based microbicides appear to provide the best hope for a new, efficacious biomedical prevention intervention.
Highlights
AIDS 2008, took place two years before the deadline for universal access, and significant attention was devoted to the theme of the conference: Universal Action Now!, in the context of both increases in the pace of scaling up treatment and care interventions and the growing realization that few countries are on target to meet universal access goals
This 1,679-person analysis of the US HIV Outpatient Study cohort found that a CD4 count under 350 cells/mm3 when first measured independently raised the risk of new cardiovascular disease more than 75% [5] Additional evidence supporting the clinical value of earlier intervention with antiretrovirals could lead World Health Organization (WHO) advisors to review guidelines on when to start ART in resource-limited countries
Ethnicity data from the CASTLE study indicated that while both treatment modalities in this study provided promising virologic and immunological results across ethnic sub-groups, there was some variation in the magnitude between different ethnic/racial groups, with ranges of those reaching undetectable levels of viremia ranging from 71% to 83% in the atazanari/r arm to 73% to 90% in the lopvinavir/r arm, with the lowest proportion of those achieving undetectable viremia among African Americans and the highest proportion among Asians or Caucasians
Summary
Address: 1Mark Mascolini, Allentown, 18102, USA, 2Kort Consulting, Toronto, M4Y 2T6, Canada and 3David Gilden, New York, 10025, USA. The AIDS 2008 Impact Report: From Evidence to Action Shirin Heidari and Regina Aragon Reviews http://www.biomedcentral.com/content/pdf/1758-2652-12-S1-info.pdf
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