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IAS 2013: Conference Opens with Focus on Aging, Global Guidelines, Drug Users

The 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) kicked off Sunday in Kuala Lumpur, Malaysia. Highlights of the first day included the release of new World Health Organization (WHO) antiretroviral therapy guidelines, a high-level panel on drug policy and public health, and a keynote address on HIV and aging.

The HIV Pathogenesis meeting is held every other year, alternating with the larger International AIDS Conference. This year's location encourages a focus on HIV/AIDS in Asia, where the epidemic is largely driven by injection drug use. Malaysia was selected in part because of its successful implementation of harm reduction efforts -- in the face of considerable public opposition -- that have dramatically reduced HIV incidence among people who use drugs, according to local conference co-chair Adeeba Kamarulzaman from the University of Malaya.

Drug policy and its impact on HIV/AIDS was the topic of a high-level panel on Sunday sponsored by the Global Commission on Drug Policy and IAS. The panel brought together speakers representing the Malaysian government, police, the legal profession, and drug users to discuss Malaysia's shift from zero-tolerance prohibition to harm reduction and regarding drug use as a public health issue (full report forthcoming).

Also on Sunday, WHO released updated treatment guidelines recommending that people with HIV worldwide should start antiretroviral therapy when their CD4 cell count falls below 500 cells/mm³, matching current guidelines in the U.S. The previous WHO guidelines set the initiation threshold at 350 cells/mm³.

Furthermore, WHO now recommends that all treatment-naive HIV positive adults should be offered the same regimen, a single once-daily pill containing efavirenz, tenofovir, and either emtricitabine or lamivudine (Atripla or a generic equivalent).

According to a WHO press release, raising the CD4 threshold "could avert an additional 3 million deaths and prevent 3.5 million more new HIV infections between now and 2025."

The change is not without controversy, however, as many people eligible for treatment under the old guidelines are not yet receiving it, and earlier treatment could do more harm than good in countries that still use older, more toxic antiretroviral drugs.

HIV and Aging

Steven Deeks from the University of California at San Francisco gave the conference's keynote address Sunday evening, focusing on HIV and aging -- and in particular, how persistent inflammation in people who suppress viral load on antiretroviral therapy raises the risk of co-morbid conditions such as cardiovascular disease.

Research towards a cure for HIV -- the topic of a 2-day IAS pre-conference meeting -- is generating "lots of excitement," Deeks said. Some approaches are moving into early clinical testing, but there are "substantial barriers" to curing HIV infection.

"I spend my time in the clinic talking about exercise, management of lipids, a Mediterranean diet, and so forth. That is the future of HIV care," he concluded. "We should all be helping our patients in their 40s and 50s live to their 70s and 80s so they're around for a cure."

The full IAS 2013 program is available online and abstracts will be posted in accordance with conference embargo policies. Follow news on Twitter using hashtag #IAS2013.

HIVandHepatitis.com is on site in Kuala Lumpur to bring you daily news from the conference, and will be working with NAM (www.aidsmap.com), the IAS official online partner for scientific reporting. Follow us on Twitter @HIVandHepatitis.

6/30/13

Sources

7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. http://www.ias2013.org.

Global Commission on Drug Policy and International AIDS Society. High Level Panel on Drug Policy and Public Health. June 30, 2013.

WHO issues new HIV recommendations calling for earlier treatment. Press release. June 30, 2013.