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Author: Tafireyi Marukutira
Event Title: Conference on Retroviruses and Opportunistic Infections 2012
5-8 March 2012
Conference report
1) Objectives for attending this conference:
19th Conference on Retroviruses and Opportunistic Infections (CROI). CROI is a scientifically focused meeting of the world’s leading researchers working to understand, prevent, and treat HIV/AIDS and its complications. The goal of CROI is to provide a forum for translating laboratory and clinical research into progress against the AIDS epidemic.
While there are many subjects to be covered in this conference, I mainly followed the following subjects matters:
- HIV transmission and primary/acute infection;
- gene therapy, immune-based therapies, and vaccines; human genomics;
- antiretroviral therapy (preclinical, randomized clinical trials, observational studies, and complications);
- HIV drug resistance; clinical pharmacology;
- complications of HIV infection;
- tuberculosis and opportunistic infections;
- AIDS-related malignancies;
- pediatrics/adolescents; maternal/fetal;
- HIV in women/women's health;
- prevention studies;
- and research on delivery of care in developing countries.
2) Agenda of the conference
The mission of CROI is to provide a forum for basic scientists and clinicians to present, discuss, and critique their investigations into the biology and epidemiology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic.
At the completion of this activity, the participants should be able to:
1) appraise and critique their individual efforts in light of the most current knowledge and information about HIV/AIDS and its complications;
2) integrate into their respective professional medical endeavors those best practices emerging from laboratory, clinical, and epidemiological research; and
3) translate the latest laboratory and clinical research into making progress against the AIDS epidemic.
The subjects that will be highlighted are
- virology;
- molecular epidemiology;
- HIV immunology;
- pathogenesis and immunopathogenesis;
- neuropathogenesis and neurologic complications;
- HIV transmission and primary/acute infection;
- gene therapy, immune-based therapies, and vaccines; human genomics;
- antiretroviral therapy (preclinical, randomized clinical trials, observational studies, and complications);
- HIV drug resistance; clinical pharmacology;
- complications of HIV infection;
- tuberculosis and opportunistic infections;
- hepatitis viruses;
- AIDS-related malignancies;
- pediatrics/adolescents; maternal/fetal;
- HIV in women/women's health;
- HIV clinical diagnostics;
- epidemiology of HIV infection;
- sexually transmitted infections;
- prevention studies;
- and research on delivery of care in developing countries.
3) Did attendance to this conference meet the needs you originally described?
Please explain your answer in either way
Yes the needs of the conference were met and the highlights from the conference are highlighted below.
4) Please highlight what was the most important/useful information you learnt during the conference:
a) First day presentations were mainly for young investigators, stimulating them for further research ideas
- Progress in HIV vaccine research: now also focusing on neutralizing antibodies
- HIV prevention research: PrEX study (MSM), CAPRISA (Tenofovir gel), TDF2 (High risk, Botswana), FemPrEP, partners PrEP (discordant couples), Topical PrEP, VOICE (MTN 003), treatment as prevention. Check out AVAC website
- Complications of HIV disease and ART: Important to always consider both these factors when managing HIV patients
- HIV reservoirs and cure research: Latent reservoirs making it difficult to find a cure.
- PMTCT: Assessing the pros and cons of AZT/NVP vs triple therapy
- Clinical trial designs: Focused on cluster randomized trials.
- Surrogate end-points: Should provide reliable inferences about clinical treatment effects and these can be biomarkers such as CD4/VL. Allows prediction of a clinically important outcome
- Incorporating new data and changing standards of care into clinical trials: This is an ethical requirement and should appear in the informed consent and the DMC is critical. With new data or change in standards the study may be changed and un-blinding required, reconsenting etc.
- Defying the structure and variability of HIV with broadly neutralizing antibodies: broadly neutralizing monoclonal antibodies (bnMAbs) promising as vaccine for HIV.
- Prevention strategies: Now many beyond ABC, Circumcision, ART for prevention, tenofovir gel, PrEP, PEP, treatment of STIs, PMTCT strategies. Adherence extremely important to many of these strategies.
b) Second day presentations focused on antiretroviral therapy for prevention
- ART for prevention: need for HIV testing, CD4 monitoring, retention in care before ART and during ART, adherence and scaling up. All depends on viral suppression across the board. ART for prevention is just part of the multi-component approach to HIV prevention.
- Hormonal contraception increase HIV acquisition but not progression of HIV disease, research has shown.
- Exposure to sdNVP does not necessarily preclude the use of NVP in an ART regimen in future for the pediatric population.
- Malaria and HIV: Risk of malaria is high in endemic areas in people living with HIV. Patients in endemic areas on LPV/r were found to have low incidences of malaria and for those developing malaria and being treated with arthemether-lumafentrine (AL). Possible mechanisms are the antimalarial effects of LPV/r as well as the drug-drug interactions with ritonavir which increases the levels of AL by inhibiting the CYP enzymes.
- Treatment interruptions in the pediatric population. Results have been disappointing but promising from the CHER study which shows good results in babies initiating ART in their first year of life and going on to interruption after their 1st birthday.
- Lipoatrophy with D4T is still an issue in the pediatric population as well as lipodystrophies with protease inhibitors.
c) Day three focused on mother to child transmission (MTCT) of HIV. The target is to reduce MTCT to <5% by 2015, reduce the number of new infections by 90% in children and to reduce maternal deaths by 50%.
- Treatment of HIV in resource limited settings, the impact and challenges: The injection of funding in these regions has led to reduction in mortality but other factors are in play. There is need for retention of patients in care if successes are to be fully realized.
- Pediatrics: Protease inhibitors are known to cause prematurity and so the mortality in HIV-exposed but uninfected infants is related to prematurity. Further data is required to assess the vulnerability of the uninfected but HIV exposed infants. Improve the care of HIV infected women such as management of infections such as CMV which may affect their newborn babies.
- Early infant HIV testing is important to identify infected children who should be started on ART early.
d) Day four focused on Tuberculosis and other opportunistic conditions/infections
- Focus on Tuberculosis (TB): Need for the development of novel anti-TB regimens which are shorter, tolerable, safe and minimum drug-drug interactions.
- AIDS and the Global burden of disease: The following metrics are used for population health-
Death
Years of life lost
Years lived with morbidity and impairments (YLDs)
Disability adjusted life years (DALYs)
Years of life lost (YLL).
- South Africa has the highest female obesity worldwide.
- HIV malignancies
5) What ideas/recommendations did you bring back? (1 page max)
- While there is still no vaccine for HIV, there are promising clinical trials of candidate vaccines. The focus of vaccine development is now on neutralising antibodies. While there is no vaccine there are many prevention approaches that countries can adopt in the meantime such as the following:
Circumcision should be implemented in all countries with high prevalence. Circumcision however should not be taken as a sole prevention strategy because barrier methods such as condoms are still important.
Abstinence and being faithful should still be preached especially to appropriate audiences.
Microbicides: The dream has been rekindled and soon we will have tenofovir gel as an option
Treatment for prevention. While this may be out of reach for many developing countries it is still important to ensure that all eligible patients are on treatment.
Pre-exposure prophylaxis with antiretroviral therapy is emerging as an option as well
Treatment of sexually transmitted diseases should still be emphasised.
Prevention of mother to child transmission (PMTCT) has shown rates of <1% with the use of triple ART.
With all these options, adherence is extremely important especially if treatment for prevention is going to be adopted as a strategy.
Be cognisant of the fact that not all ART drugs are safe during pregnancy and protease inhibitors have been shown to cause prematurity. Prematurity is a known cause for high mortality rates in children.
6) How will you incorporate them in your research or training activities
- There is a planned presentation to the Botswana HIV Clinicians Society CME meetings in the form of a summary of the highlights from CROI in April/May 2012 in Botswana. This will be a platform to update key stakeholders on the scientific findings from the conference.
7) How could others benefit from the conference?
- Most of the scientific findings from research reported from CROI are still to have solid backing from international bodies such as the World Health Organisation. But at this stage it is important for clinicians on the ground to have the information before policy makers and Public Health advisors put the information into policy.
8) Would you recommend other grantees attend this conference?
Yes I would recommend grantees to attend this conference based on the wide scope of scientific areas covered under infectious diseases.