XV International AIDS Conference Focuses on ‘Politics’ of Increasing Antiretroviral Drug Access

The XV International AIDS Conference in Bangkok, Thailand, which ended Friday, focused on the "politics" of increasing access to antiretroviral drugs for people in the developing world, the AP/Long Island Newsday reports. Since the XIV International AIDS Conference in Barcelona, Spain, in 2002, the number of people on antiretrovirals in developing countries has doubled to 440,000, according to World Health Organization statistics. However, only about 7% of those in poor countries who need the treatment have access to it, and there has been no overall improvement in the proportion of people with access to treatment and prevention, according to the United Nations. "We are all going to walk away from this meeting knowing we have a long way to go with regard to access, because the countries that have the greatest need still have the least access," National Institute of Allergy and Infectious Diseases Director Anthony Fauci said (AP/Long Island Newsday, 7/18).

Prevention Efforts
Scientists at the conference presented "distinctly mixed report[s]" on progress in prevention efforts, including the development of vaccines, microbicides and pills to prevent HIV infection, according to the Washington Post. Although the number of vaccine candidates being tested has expanded from seven to 22 since the XIV International AIDS Conference, many experts say that an effective vaccine might not be available for more than 10 years (Nakashima/Brown, Washington Post, 7/17). According to a report released July 12 by the International AIDS Vaccine Initiative, the effort to develop a vaccine needs almost a doubling of funds, and researchers might have to start over if the current approach fails (Kaiser Daily HIV/AIDS Report, 7/13). Research on microbicides, which might be somewhat closer to development, could be "[n]early as important" as a vaccine in preventing the spread of HIV, the Post reports (Washington Post, 7/17). Microbicides include a range of products such as gels, films, sponges and other products that could help prevent the sexual transmission of HIV and other sexually transmitted diseases. Zeda Rosenberg, CEO of the International Partnership for Microbicides-- which is calling for a $1 billion microbicide research project -- said at the conference that although six microbicides are slated to begin clinical trials, she does not expect an effective microbicide to be available for between five and seven years (Kaiser Daily HIV/AIDS Report, 7/16). UNAIDS Executive Director Peter Piot said that prevention efforts must be boosted "with the passion and urgency that is being brought to treatment," adding, "Without a greatly expanded prevention effort, treatment is simply not sustainable" (Washington Post, 7/17).

Science
The Bangkok conference included "very little science," compared with past conferences that were "marked by major breakthroughs in drug therapy," increased understanding of how HIV works and "new insights into how some people resist infection," the Los Angeles Times reports. In addition to discussion of vaccines and microbicides, "small" scientific developments were announced during the conference, according to the Times. For example, Dr. Joel Gallant of Johns Hopkins University presented promising findings on reducing side effects associated with antiretroviral drug therapy. Gallant and colleagues found that a drug regimen including tenofovir and lamivudine was as effective as the more common regimen of stavudine and lamivudine, but had significantly fewer side effects. In addition, a Medecins Sans Frontieres study said that fixed dose combination antiretroviral drugs were as effective as brand-name regimens in treating HIV in developing countries (Maugh, Los Angeles Times, 7/17). The study, conducted in 21 developing countries, was the first large-scale study of the generic fixed dose drugs, which require two pills a day and cost about $140 per person per year. A regimen of the same three drugs purchased separately from patent holders GlaxoSmithKline, Bristol-Myers Squibb and Boehringer-Ingelheim requires six pills per day and costs about $562 per patient per year (Kaiser Daily HIV/AIDS Report, 7/15). In addition, Roche presented the results of a 96-week trial of its antiretroviral drug Fuzeon. Although critics have predicted that many people will discontinue use of the drug because it requires twice daily injections, the researchers found that more than half of study participants continued to take the drug (Los Angeles Times, 7/17).

Reaction
Many people on Sunday debated whether the conference was an effective contribution to the fight against AIDS or an "unwieldy bureaucratic giant," according to the AFP/Australian Broadcasting Corporation. In addition to concern that the conference had the least attendance by scientists of any past summit, many were concerned about the size of the event, which was attended by nearly 20,000 people. "It was way too big, which affected the quality, and used up a lot of money that could have been better spent," Nimit Tienudom, director of Thailand's AIDS Access Foundation, said. The conference "failed to deliver any new innovations or knowledge," Nimit added. "I would like something smaller but the impact of a conference like this may actually be larger than doing something smaller," Dr. Joep Lange, outgoing president of the International AIDS Society and conference co-chair, said, adding, "Despite the fact that there is a lot of blah, blah, the conference has become very powerful" (AFP/Australian Broadcasting Corporation, 7/17). Thai Sen. Mechai Viravaidya said that the conference raised both awareness about the pandemic as well as the accountability of world leaders. "I truly believe that, for the first time, there is a real chance that we will get ahead of this epidemic," Piot said (AP/Long Island Newsday, 7/18).