Conference On Retroviruses And Opportunistic Infections Research Articles

Conference on retroviruses and opportunistic infections (virtual): March 6-10, 2021.

The Conference on Retroviruses and Opportunistic Infections (CROI) for 2021 was, as with so many other conferences in the past 12 months, held online. CROI provided a forum for basic scientists and clinical researchers to bring together and discuss their work on human retroviruses and associated diseases, with HIV and SARS-CoV-2 being the two viruses most covered this year. Below are some examples of the work presented at the conference, highlighting both the innovative approaches to understanding and treating viral infections but also the breadth of topics covered.

David Katzenstein and James Hakim-In Memoriam.

The world lost two wonderful doctors who devoted their lives to the fight against HIV/AIDS in Africa. Ironically, they both died of COVID-19 within hours of each other in late January in Zimbabwe. David Katzenstein, MD, began his career in the early 1980 s working with underserved populations at a Native Tribal clinic in New Mexico and with persons suffering from AIDS at the Haight Ashbury Clinic in San Francisco, conducted CMV research at the University of Minnesota, and then took a position working as a microbiologist at the University of Zimbabwe in Harare between 1985 and 1987. In 1989, David joined the faculty at Stanford University where he remained until his retirement in 2017. Dr Katzenstein, led many important clinical and translational research studies related to HIV. With his colleagues in the AIDS Clinical Trials Group (ACTG), he led studies that resulted in the approval of life-saving antiretroviral medications. David dedicated a major portion of his academic endeavors to study HIV drug resistance, serving as director of one of the Virology Specialty Laboratories for the ACTG for many years. He was a protocol team member and leader on several ACTG studies and served on numerous ACTG committees, including the Performance Evaluation Committee and the original Virology Committee. He was co-chair of ACTG 384 that dealt with protease and/or non-nucleoside reverse transcriptase inhibitors, and was one of the first investigators to call attention to the issues of drug resistance in Africa. Recognizing the disparate impact of HIV in resource limited settings, David was a pioneer in Global HIV Research, in the fields of perinatal HIV transmission prevention, and studying different approaches to optimize antiretroviral treatment and laboratory monitoring in various settings around the world. He worked diligently to bring laboratory technology to Zimbabwe. Following his retirement from Stanford in 2017, David became the director of the Biomedical Research Training Institute in Zimbabwe where he led the molecular diagnostics laboratory to support laboratory monitoring of community-based treatment programs. In all his work, David engaged researchers and trainees from different parts of the world. Generous with his time, effort and ideas, David was a cherished mentor for many young and mid-career physicians and scientists, now scattered throughout different academic institutions and agencies in the U.S. He nurtured careers of clinicians, basic and social scientists, while encouraging multidisciplinary efforts to tackle the global HIV pandemic. He worked tirelessly and with great joy, giving of himself without reserve. James Gita Hakim, MRCP-UK, Professor of Medicine, University of Zimbabwe College of Health Sciences, to COVID-19. Dr Hakim was an accomplished investigator who made seminal contributions in HIV treatment and prevention research. He was known internationally for his accomplishments as a research leader, a builder of African research capacity, a leader of modernizing medical education in Africa, and as a mentor of young African investigators. Dr Hakim was at the forefront of clinical research on HIV/AIDS in Africa for over 20 years. He founded the University of Zimbabwe Clinical Research Centre (UZ-CRC) in 2001 as a site for international clinical trials on HIV treatment and prevention. He was a leader in pivotal international clinical trials including the landmark HIV ‘treatment as prevention’ trial HPTN 052, the MRC-funded “Development of Anti-Retroviral Therapy in Africa” (DART) trial, and the ACTG “Prospective Evaluation of Antiretroviral Therapy in Resource Limited Settings” (PEARLS) study. These studies contributed to the knowledge needed for successful implementation of antiretroviral therapy in southern Africa. Dr Hakim was as Principal Investigator of the University of Zimbabwe's program, the Medical Education Partnership Initiative (MEPI) which serves as a model for medical education in Africa. He was as a representative on the International AIDS Society (IAS) Governing Council from 2016 to 2020 and on the World Health Organization Guidelines Review Committee, the UNAIDS Advisory Committee, and on program committees for IAS Conference on HIV Science, the Conference on Retroviruses and Opportunistic Infections (CROI). Dr Hakim was Co-chair of the World AIDS Conference, Amsterdam, Netherlands in 2018. James Hakim's life demonstrated how investment in biomedical research and modern medical education can pay large dividends and be transformative for Africa. The world is better for the lives you lived, David and James. May light perpetual shine upon you.

1016. Global trends in Integrase Strand Transfer Inhibitor resistance among HIV-1B Infected Patients

BackgroundIntegrase strand transfer inhibitors (INSTIs), a new class of antiretroviral (ART) therapy for HIV, have quickly become a cornerstone of ART regimens globally. Here, we present the prevalence of INSTI resistance globally and over time among people living with HIV/AIDS (PLWHA), clade B.MethodsTo characterize trends in INSTI resistance, we conducted a literature search of articles published after 2010 via Pubmed and posters/abstracts from the Conference on Retroviruses and Opportunistic Infections (CROI) from 2016-2020. Included in our analysis are studies that include more than 100 individuals with INSTI resistance testing, who are infected with HIV clade B. We stratified the studies by country and by time period. We defined two time periods, 2008-2015 during which primarily first generation of INSTI were used (raltegravir and elvitegravir), and 2015-2020 during which second generation INSTIs (dolutegravir and bictegravir) use became widespread. We considered drug-resistance associated mutations (DRAM) in both ART-naive and in ART-experienced PLWHA.ResultsOverall, we reviewed 31 papers and 11 CROI abstracts that met the inclusion criteria. We observed that prevalence of DRAM in naïve patients is low globally and has remained low over time, ranging from 0%-8%. Meanwhile, we observed a downward trend in DRAM among INSTI-experienced patients from the 2008-2015 period to the 2015-2020 period from 11%-47.6% to 8%- 32.1%, reflecting higher barrier to resistance described in vivo among the 2nd generation INSTIs. See table below.INSTI Resistance Summary Results Table ConclusionHere, we have analyzed the trends in INSTI prevalence over time and in different countries for HIV1 clade B. We demonstrate that globally, INSTI DRAM among INSTI-naïve patients are rare and incidence does not increase significantly over time despite increased usage. In addition, published studies showed a downward trend in INSTI DRAM among INSTI-experienced patients after 2015, reflecting the higher barrier to resistance in the second generation INSTIs. The most commonly occurring INSTI DRAMs observed were N155H (more common in the era of f1st generation INSTI), Q148H/K/R, and G140S. As INSTI usage continues to increase globally, continued vigilance and surveillance is needed to monitor continued INSTI resistance over time.Disclosures All Authors: No reported disclosures

Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome.

Advances and challenges in antiretroviral therapy for acquired immunodeficiency syndrome.

Conference on Retroviruses and Opportunistic Infections (CROI) 2020. March 8-11, 2020

The current pandemic of the novel coronavirus SAR-CoV-2, and the disease it causes known as COVID-19, resulted in this years' annual Conference on Retroviruses and Opportunistic Infections (CROI) being held virtually, with presentations being made via webcasts and posters available online This did not prevent the conference from providing its usual high-quality data to its participants including basic, translational and clinical researchers from around the world covering developments and research methods in the ongoing battle against HIV/AIDS and related infectious diseases Adapting to the unique situation, CROI also held a special session on the COVID-19 virus, with experts providing the information on current knowledge of the outbreak and its causative pathogen At the time of the conference, the virus had affected over 110,000 people from over 110 countries and treatments and vaccines are yet to be discovered Copyright © 2020 Clarivate Analytics

Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis

BackgroundDespite substantial improvements in accessibility of Anti-Retroviral Treatment (ART), death of children on ART remains a prevailing challenge in sub-Saharan African (SSA) countries. However, the pooled magnitude of mortality at different ART follow-up periods remains unknown for the region. We estimated the pooled proportion of all-cause mortality for pediatric patients receiving first-line ART at 3, 6, 12, and 24 months follow-up period in SSA.MethodsWe searched for relevant articles published between January 2014 and June 2018 on PubMed, Hinari and Google scholar databases. We searched for additional articles from reference lists and 2014–2018 abstracts archived by the Conference on Retroviruses and Opportunistic Infections (CROI) and the International AIDS Society Conference on HIV Science (IAS).ResultsWe reviewed 29 articles reporting mortality among pediatric ART patients at different follow-up periods in countries from 2001 to 2016. Among the 51,619 pediatric ART patients in these cohorts, studies reported 4061 (7.9%) all-cause cumulative death. The cumulative pooled proportion of mortality at 3, 6, 12 and 24 months of ART were 3% (95% CI: 3.0–4.0), 5% (95% CI: 4.0–6.0), 6% (95% CI: 5.0–7.0) and 7% (95% CI: 6.0–8.0), respectively.ConclusionsIn SSA, significant proportion of mortality among children occurs in the first 3–6 months of ART initiation. Western Africa has a little higher estimate of mortality among pediatric ART patients at 6 and 12 months of follow-up. Strategies to prevent early mortality including thorough screening and management of opportunistic infections before ART initiation are needed.

Primary antifungal prophylaxis for cryptococcal disease in HIV-positive people.

BackgroundCryptococcal disease remains one of the main causes of death in HIV‐positive people who have low cluster of differentiation 4 (CD4) cell counts. Currently, the World Health Organization (WHO) recommends screening HIV‐positive people with low CD4 counts for cryptococcal antigenaemia (CrAg), and treating those who are CrAg‐positive. This Cochrane Review examined the effects of an approach where those with low CD4 counts received regular prophylactic antifungals, such as fluconazole.ObjectivesTo assess the efficacy and safety of antifungal drugs for the primary prevention of cryptococcal disease in adults and children who are HIV‐positive.Search methodsWe searched the CENTRAL, MEDLINE PubMed, Embase OVID, CINAHL EBSCOHost, WHO International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, conference proceedings for the International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI), and reference lists of relevant articles up to 31 August 2017.Selection criteriaRandomized controlled trials of adults and children, who are HIV‐positive with low CD4 counts, without a current or prior diagnosis of cryptococcal disease that compared any antifungal drug taken as primary prophylaxis to placebo or standard care.Data collection and analysisTwo review authors independently assessed eligibility and risk of bias, and extracted and analysed data. The primary outcome was all‐cause mortality. We summarized all outcomes using risk ratios (RR) with 95% confidence intervals (CI). Where appropriate, we pooled data in meta‐analyses. We assessed the certainty of the evidence using the GRADE approach.Main resultsNine trials, enrolling 5426 participants, met the inclusion criteria of this review. Six trials administered fluconazole, while three trials administered itraconazole.Antifungal prophylaxis may make little or no difference to all‐cause mortality (RR 1.07, 95% CI 0.80 to 1.43; 6 trials, 3220 participants; low‐certainty evidence). For cryptococcal specific outcomes, prophylaxis probably reduces the risk of developing cryptococcal disease (RR 0.29, 95% CI 0.17 to 0.49; 7 trials, 5000 participants; moderate‐certainty evidence), and probably reduces deaths due to cryptococcal disease (RR 0.29, 95% CI 0.11 to 0.72; 5 trials, 3813 participants; moderate‐certainty evidence). Fluconazole prophylaxis may make no clear difference to the risk of developing clinically resistant Candida disease (RR 0.93, 95% CI 0.56 to 1.56; 3 trials, 1198 participants; low‐certainty evidence); however, there may be an increased detection of fluconazole‐resistant Candida isolates from surveillance cultures (RR 1.25, 95% CI 1.00 to 1.55; 3 trials, 539 participants; low‐certainty evidence). Antifungal prophylaxis was generally well‐tolerated with probably no clear difference in the risk of discontinuation of antifungal prophylaxis compared with placebo (RR 1.01, 95% CI 0.91 to 1.13; 4 trials, 2317 participants; moderate‐certainty evidence). Antifungal prophylaxis may also make no difference to the risk of having any adverse event (RR 1.07, 95% CI 0.88 to 1.30; 4 trials, 2317 participants; low‐certainty evidence), or a serious adverse event (RR 1.08, 95% CI 0.83 to 1.41; 4 trials, 888 participants; low‐certainty evidence) when compared to placebo or standard care.Authors' conclusionsAntifungal prophylaxis reduced the risk of developing and dying from cryptococcal disease. Therefore, where CrAG screening is not available, antifungal prophylaxis may be used in patients with low CD4 counts at diagnosis and who are at risk of developing cryptococcal disease.12 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (31 Aug, 2017) were included

Early versus delayed antiretroviral treatment in HIV-positive people with cryptococcal meningitis.

BackgroundThere remains uncertainty about the optimum timing of antiretroviral therapy (ART) initiation in HIV‐positive people with cryptococcal meningitis. This uncertainty is the result of conflicting data on the mortality risk and occurrence of immune reconstitution inflammatory syndrome (IRIS) when ART is initiated less than four weeks after cryptococcal meningitis treatment is commenced.ObjectivesTo compare the outcomes of early initiation of ART (less than four weeks after starting antifungal treatment) versus delayed initiation of ART (four weeks or more after starting antifungal treatment) in HIV‐positive people with concurrent cryptococcal meningitis.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase for trials published between 1 January 1980 and 7 August 2017. We additionally searched international trial registries, including ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP), and conference abstracts from the International AIDS Society (IAS) and the Conference on Retroviruses and Opportunistic Infections (CROI) for ongoing or unpublished studies between 2015 and 2017. We reviewed reference lists of included studies to identify additional studies.Selection criteriaWe included randomized controlled trials (RCTs) that compared early versus delayed ART initiation in HIV‐positive people with cryptococcal meningitis. Children, adults, and adolescents from any setting were eligible for inclusion.Data collection and analysisTwo review authors independently applied the inclusion criteria and extracted data. We presented dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CIs). We presented time‐to‐death data as hazard ratios with 95% CIs. We assessed the certainty of the evidence using the GRADE approach.Main resultsFour trials including 294 adult participants met the inclusion criteria of this review. Participants were predominantly from low‐ and middle‐income countries. Two trials treated cryptococcal meningitis with amphotericin B and fluconazole; a third trial used fluconazole monotherapy; and the fourth trial did not specify the antifungal used.Early ART initiation may increase all‐cause mortality compared to delayed ART initiation (RR 1.42, 95% CI 1.02 to 1.97; 294 participants, 4 trials; low‐certainty evidence). Early ART initiation may reduce relapse of cryptococcal meningitis compared to delayed ART initiation (RR 0.27, 95% CI 0.07 to 1.04; 205 participants, 2 trials, low‐certainty evidence). We are uncertain whether early ART initiation increases or reduces cryptococcal IRIS events compared to delayed ART initiation (RR 3.56, 95% CI 0.51 to 25.02; 205 participants, 2 trials; I2 = 54%; very low‐certainty evidence). We are uncertain if early ART initiation increases or reduces virological suppression at six months compared to delayed ART initiation (RR 0.93, 95% CI 0.72 to 1.22; 205 participants, 2 trials; I2 statistic = 0%; very low‐certainty evidence).We were unable to pool results related to rate of fungal clearance for the two trials that reported this outcome; individual trial results indicated that there was no difference in cerebrospinal fluid fungal clearance between trial arms. Similarly, we were unable to pool results on adverse events for the trials reporting on this outcome; individual trial results indicated no difference in the occurrence of grade 3 to 5 adverse events between trial arms.Three of the four included trials had an overall low or unclear risk of bias related to the primary outcome of all‐cause mortality. However, we assessed one trial as at high risk of bias due to selective outcome reporting and other bias. This, in addition to the few clinical events and imprecision of effect estimates, led to downgrading of the evidence to low or very low certainty.Authors' conclusionsThe results of this review are relevant to HIV‐positive adults with cryptococcal meningitis in low‐ and middle‐income countries. These data suggest a higher risk of mortality among people who initiate ART within four weeks of cryptococcal meningitis diagnosis. However, it is unclear if this higher mortality risk is related to cryptococcal meningitis‐IRIS.11 April 2019Up to dateAll studies incorporated from most recent searchAll eligible published studies found in the last search (7 Aug, 2017) were included

Tenofovir Alafenamide Versus Tenofovir Disoproxil: Systematic Review and Meta-analysis (Protocol)

Highly active antiretroviral therapy (HAART) has greatly reduced morbidity and mortality, resulting in high survival rates among infected patients. Despite the impact of HAART, mortality in successfully treated HIV infected patients remains higher than in the general uninfected population. The effects of persistent inflammation and drug toxicity on comorbidities that are considered non-HIV related, including metabolic, cardiovascular and renal disease, contribute to these differences in the health of infected individuals New Reference. Among antiretroviral moleculars, tenofovir disoproxil is widely used. Tenofovir alafenamide is a new oral prodrug of tenofovir, a nucleotide analogue that inhibits HIV-1 transcription. Tenofovir alafenamide has potential intracellular accumulation; lower extracellular exposures of tenofovir may be realized with the potential to reduce off-target toxicities. Specifically, lower drug exposures to kidney cells may provide for fewer renal complications as observed in a minority of patients treated with tenofovir disoproxil fumarate. Objectives To investigate whether Tenofovir alafenamide based regimens are less nephrotoxic than Tenofovir disoproxil based regimens. To evaluate whether Tenofovir alafenamide contained regimens could decrease mineral bones loss. To investigate the efficacy of TAF in co-infection HIV/hepatitis. Search methods: We will search the following electronic databases: CENTRAL (Cochrane Central Register of Controlled Trials), Scorpus, Web of science, LILACS, PubMed and CINAHL. We will also search conference abstract archives on the web sites of the Conference on Retroviruses and Opportunistic Infections (CROI), the International AIDS Conference (IAC), and the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS). Analysis: If include studies are as similar as possible, we will undertake meta-analysis using Cochrane’s Review Manager Software (RevMan 2014). If included studies are heterogeneous, the results will be summarized in a narrative manner. GRADE evidence profiles and summary of findings tables will be generated. Conclusion: This study could influence HIV management. TDF is largely used as first line regimen in HIV management. Therefore toxicity is restricted its use. This systematic review will find out whether TDF could be swift by TAF when TDF is contraindicated.

A report from the Conference on Retroviruses and Opportunistic Infections (CROI) 2015 (February 23-26--Seattle, Washington, USA).

The largest conference on HIV and AIDS, the annual Conference on Retroviruses and Opportunistic Infections (CROI) also encompasses opportunistic and other important pathogens, notably in 2015 hepatitis C virus and the Ebola virus. This year's conference involved 4 days of discussions on highly relevant basic, translational and clinical research and developments in the ongoing battle against these infections.

Mesenchymal stem cell therapy in HIV-infected HAART-treated nonimmune responders restores immune competence

Mesenchymal stem cell therapy in HIV-infected HAART-treated nonimmune responders restores immune competence

Report from the 20th Conference on Retroviruses and Opportunistic Infections

The Conference on Retroviruses and Opportunistic Infections (CROI) is the leading scientific meeting in the field, this year taking place for the first time in Atlanta. It was a site believed by some to be particularly fitting, given …

Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

BackgroundAntiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity. However, other morbidities appear to be more common among PLHIV than in the general population. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV) compared to the HIV-uninfected population.MethodsWe conducted a systematic review and meta-analysis of relative risks of renal disease among populations of PLHIV reported in studies from the peer-reviewed literature. We searched Medline for relevant journal articles published before September 2010, yielding papers published during or after 2002. We also searched conference proceedings of the International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI) prior to and including 2010. Eligible studies were observational studies reporting renal disease defined as acute or chronic reduced renal function with glomerular filtration rate less than or equal to 60 ml/min/1.73 m2 among HIV-positive adults. Pooled relative risks were calculated for various groupings, including class of ART drugs administered.ResultsThe overall relative risk of renal disease was 3.87 (95% CI: 2.85-6.85) among HIV-infected people compared to HIV-uninfected people. The relative risk of renal disease among people with late-stage HIV infection (AIDS) was 3.32 (1.86-5.93) compared to other PLHIV. The relative risk of renal disease among PLHIV who were receiving antiretroviral therapy (ART) was 0.54 (0.29-0.99) compared to treatment-naïve PLHIV; the relative risk of renal disease among PLHIV who were treated with tenofovir was 1.56 (0.83-2.93) compared to PLHIV who were treated with non-tenofovir therapy. The risk of renal disease was also found to significantly increase with age.ConclusionPLHIV are at increased risk of renal disease, with greater risk at later stages of infection and at older ages. ART prolongs survival and decreases the risk of renal disease. However, less reduction in renal disease risk occurs for Tenofovir-containing ART than for other regimens.

Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection

Population-based biomedical sexually transmitted infection control interventions for reducing HIV infection

Sperm washing to prevent HIV transmission from HIV-infected men but allowing conception in sero-discordant couples

Sperm washing is a term used to describe the process in which individual spermatozoa are separated from the seminal fluid. Sperm washing is used to prevent HIV transmission but allow conception in sero-discordant couples, where the male is HIV positive, but the female is HIV negative. This procedure is based on the observation that HIV cannot attach itself to spermatozoa, but it can be found in the fluid and cells surrounding spermatozoa. To determine the benefits and harms of sperm washing of HIV-infected males when used to prevent the transmission of HIV but allowing conception in the HIV-negative female. We searched the Cochrane HIV/AIDS Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCORPUS, AIDsearch, AJOL, LILACS and INDEX MEDICUS. We also searched the following conference proceedings for relevant abstracts:The International AIDS Conference; The Conference on Retroviruses and Opportunistic Infections (CROI); The British HIV Association (BHIVA) Conference; The International Conference of Obstetricians and Gynecologists (FIGO); The American Academy of HIV Medicine Conference; The Australasian HIV/AIDS Conference; The American Society for Reproductive Medicine (ASRM) conferences and website; The European Society for Human Reproduction and Embryology (ESHRE) conferences and websites, and the British Fertility Society (BFS) conferences and website. We also conducted a search of the website: www.ClinicalTrials.gov. The date of the most recent Cochrane HIV/AIDS Group Controlled Trials Register search was on the 10th of November, 2010. We preferentially looked for randomised or quasi-randomised controlled trials on sperm washing, aimed at preventing HIV transmission from HIV infected men but allowing conception in sero-discordant couples, irrespective of publication status, year of publication, or language in the review. No relevant trials were identified for inclusion in this review. Forty four studies were identified, but none of them were suitable for inclusion in this review. Reports on the use of sperm washing to prevent HIV transmission from HIV infected men but allowing conception in sero-discordant couples is currently limited to observational studies. No randomised controlled trial has assessed the benefit or risk of sperm washing to prevent HIV transmission from HIV infected men but allow conception in sero-discordant couples. Thus, this systematic review identifies the need for a multicentre randomised controlled trial assessing the benefits and possible risks of sperm washing in preventing HIV transmission from HIV infected men but allow conception in sero-discordant couples.

Selected Reports From 2010 CROI (17th Conference on Retroviruses and Opportunistic Infections), San Francisco, February 16-19, 2010

Selected Reports From 2010 CROI (17th Conference on Retroviruses and Opportunistic Infections), San Francisco, February 16-19, 2010

Expanding HIV Testing and Treatment

The implicit theme of the 2010 Conference on Retroviruses and Opportunistic Infections (CROI) was “test and treat.” On the surface, this strategy

Developments in antiretroviral therapy based on data presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI)

Developments in antiretroviral therapy based on data presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI)

Developments in antiretroviral therapy based on data presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI)

Developments in antiretroviral therapy based on data presented at the 17th Conference on Retroviruses and Opportunistic Infections (CROI)

Microbicides: an emerging science of HIV‐1 prevention in women—15th Conference on Retroviruses and Opportunistic Infections, Boston, USA, 3–6 February 2008

Women account for almost 60% of human immunodeficiency virus type 1 (HIV-1) infections in Sub-Saharan Africa. HIV-1 prevention tools such as condoms, abstinence and monogamy are not always feasible options for women due to various socio-economic and cultural factors. Microbicides are anti-microbial medications formulated for topical administration to prevent the sexual transmission of HIV-1 and other pathogens. Ideally, they will afford bidirectional protection to both men and women who are engaged in vaginal or anal sex. Since the use of condom is often difficult or impossible, this multifunctional role of microbicides will be crucial in the fight against AIDS. The 15th Conference on Retroviruses and Opportunistic Infections (CROI) was recently held in Boston, USA, where one of the most interesting subject area discussed by researchers from all around the world was the latest developments and understandings in microbicide-related basic science and pre-clinical product development as well as in product manufacturing and formulation that address the issue of user adherence.