If IAS 2015 (aka the 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention) was not notable for new research, it was certainly hugely important in building resolve. It was strong too in identifying what needs to be done to use the tools and knowledge we now have to turn the epidemic around. For collectively, we seem poised now, witnessing a moment in time when the end of AIDS really does seem in sight.
Many have been singing the same tune. Said Elton John before Vancouver,”there is a new window of opportunity before us, a window through which we can clearly see the end of AIDS."
IAS presenters weighed in with similar messages. “We now have a true vision how we can end the epidemic. UNAIDS embracing 90-90-90 has opened up an entirely new conversation. We now have all the answers, we just have to do it” said co-chair Julio Montaner (whom I interview here for PositiveLite.com)
Professor Chris Beyrer: “Let this be the conference where the question of when to start treatment stops being a scientific question and starts being a question of finance and political will”. “Immediate treatment for all should be the new standard of care” said Michel Sidibe, UNAIDS head, a sentiment echoed by numerous speakers.
All this optimism comes at a time when global new infections are now showing a downward trend and when targets to have 15 million safely on treatment by 2015 were in fact met ahead of schedule!
Highlights? Despite the lack of scientific bombshells there were many notable features of the conference. Here are my own top six.
1. Being in Vancouver. Clearly the world views British Columbia as the hot bed of HIV innovation, so it’s exciting to witness that. This after all is the location of North America’s only supervised injection site. (See my account of visiting Insite here.) But it is also the birthplace of treatment as prevention, adopted sometimes eagerly, sometimes not, throughout the world. 90-90-90 has its roots here. HIV meds are free here. And it’s the home province of the most beguilingly controversial figure in HIV today, BCCFE’s Julio Montaner.
Aside from all this, Vancouver is a beautiful, engaging city with a leftist bent that both inspires and sets the right tone. It’s just plain nice to be there.
2. The benefits of starting treatment early, the conference made clear, are no longer in dispute. Now that knowledge needs to be incorporated into practical strategies that both facilitate immediate treatment access while protecting the rights of the newly-diagnosed patient.
The science behind that reality is of course START. Primary results were presented at IAS 2015. Nothing all that new here, but because START is big news, it was a hugely well attended session that had all the trappings of history being made. Read the full report from aidsmap here. (Note throughout I will be referencing aidsmap reports; they were the official provider of online scientific reporting for the conference and did a superb job.)
3. The Vancouver Consensus Statement. Building on START, the conference launched a call by important leaders for immediate access to treatment and PrEP. Says the statement “Medical evidence is clear: All people living with HIV must have access to antiretroviral treatment upon diagnosis. Barriers to access in law, policy, and bias must be confronted and dismantled. And as part of a combination prevention effort, PrEP must be made available to protect those at high risk of acquiring HIV.” Commendably, a consortium of people living with HIV leaped in with their own "Canadian Declaration by Persons Living with HIV” which essentially reinforced the provisions of the Vancouver statement from a more poz-centric perspective. You can read my story about the Canadian Declaration launch on PositiveLite.com later this week and the aidsmap report on the Vancouver statement here.
4. Undetectable still points to no new infections. The final results of HPTN 052 – the study that changed everything - were presented. The headlines tell it all: “No HIV infections from partners with fully suppressed viral load during long-term follow up of landmark treatment as prevention trial.” Can someone please pass on the message to agencies that are still using messaging like “a suppressed viral load reduces the risk of transmission?” to get with the program? Indeed those who suggest an undetectable viral load can potentially eliminate the risk of transmission, while scientifically hard to prove, (see PARTNER) seem much closer to reality. For more on this read the aidsmap report here.
5. Wold Health Organization gives a sneak peek at new guidelines that recommend treatment for ALL, irrespective of CD4 count. A bombshell? Hardly, but hugely significant as we move into an era where diagnosis and treatment start may happen on the same day. Clearly that scenario raises concerns, and one could argue that the community perspective was under-represented in stating these, but given what we know about the damage caused by HIV infection right from the get go, it’s becoming clear that when it comes to treatment, the sooner the better is the message that needs to get out, and implementation polices put in pace that make that process both protective and expedient. Read the aidsmap report here.
6. We need to do better at HIV testing with WHO once again calling for expansion of testing catchment to non-clinical settings but not, significantly, embracing home testing (yet.) Meanwhile other prevention experts were wholeheartedly embracing it. Not yet approved in Canada, it seems clear that its time will come but as with other prevention technologies (think PrEP) we need to do more proactively to make that happen. For the full aidsmap report go here.
Of necessity the list of six highlights reflects my own experience and interests and also the practicalities of conference-going. There were multiple and often concurrent sessions throughout the conference’s four days, so one has to make choices.
Personally, I found the conference a hugely valuable, albeit exhausting, experience. True, Vancouver represents an alternate reality to how the HIV epidemic is being addressed in some regions, including my own and that frustrates. Progress not just here at home is often curtailed by politics, animosity and a lack of progressive thinking. Thus in Canada we now trail less resource-rich countries in our response. But the shock to the system that comes with the realization that we are underperforming badly in relation to others, that we can do so much better – and need to, just to catch up – struck me as a healthy outcome.
Clearly we need to buckle down, regroup and rethink while redoubling our efforts in a brave, science- and target -based approach if we want to compete. And why wouldn’t we?
Thank you Vancouver, you served us well.
More IAS coverage this week:
Tuesday: Video footage of the launching of the Canadian Declaration by Persons Living with HIV
Wednesday: The new organization for people living with HIV, CPPN’s Christian Hui talks about what they want to achieve.