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AMSTERDAM -- In the 26 years since the International AIDS Conference was last held here, the treatment and prevention of HIV has been "utterly transformed" for the better, according to the meeting's local chair, Peter Reiss, MD, PhD, of the University of Amsterdam.
But that doesn't mean everything's coming up roses, Reiss told reporters in a pre-meeting teleconference. This year's AIDS conference, from July 23 through 27, will aim a spotlight on two major problem areas:
- Eastern Europe and Central Asia, the "only region in the world where both new HIV infections and deaths are rising dramatically," Reiss said. "If we don't take decisive action right now, we are on a path to disaster in Eastern Europe and Central Asia."
- And the perennial issue of money: "We are at a very dangerous point in HIV funding and policy," Reiss said, with donor contributions falling for the first time and with the U.S. having "embraced funding restrictions that could have a devastating impact."
But the meeting also will have a strong scientific focus, according to Linda-Gail Bekker, MBChB, PhD, of the Desmond Tutu HIV Centre in Cape Town, South Africa, and president of the International AIDS Society, which sponsors the biennial conference.
Some 3,000 abstracts, culled from more than 8,000 submissions, will shed light on aspects of treatment, prevention, financing, and laws and policies that, sometimes inadvertently, worsen the impact of HIV/AIDS, Bekker said.
On the prevention front, researchers will present new data on how well HIV treatment can interrupt transmission among men who have sex with men. The analysis will look at how often the virus was passed between so-called serodiscordant couples -- in which one partner has HIV and the other does not -- when the infected man was on successful therapy.
Investigators will also be reporting on a new study of so-called on-demand pre-exposure prophylaxis (PrEP) among gay men in France. The researchers randomly assigned men to get either regular PrEP, with an anti-HIV drug daily, or only when they thought they might be exposed to HIV.
A late-breaking analysis will look at potential interactions between PrEP drugs and the feminizing hormones used by transgender women, Bekker said.
Researchers will also report on the APPROACH vaccine study, with long-term data out to 78 weeks on the durability of immune responses.
The treatment piece will include information on the integrase inhibitor dolutegravir and its performance as part of an initial HIV therapy regimen that contains just two drugs, according to Sharon Lewin, MD, of the Peter Doherty Institute of Infection and Immunity in Melbourne, Australia.
The findings will likely have the potential to change clinical practice, she said, because the treatment paradigm has been to use three drugs, targeting different aspects of the viral replication cycle, in order to suppress HIV. Two-drug regimens would likely have fewer side effects, less risk of interactions with other medications, and lower costs.
Dolutegravir is also becoming the favored backbone for standard three-drug regimens, but there have been hints of serious adverse events if women take it around the time of conception. A late breaking study will analyze the risk of neural tube defects in babies whose mothers used the drug.
Research on finance looks at the impact of the so-called Mexico City rule, a U.S. policy that denies funding to agencies that advocate for access to abortion, even if they do it using non-government money, Reiss said.
In the past, that rule had only applied to domestic agencies, but the Trump administration has expanded it to almost all global health assistance. The expansion "has the potential to significantly roll back progress on HIV," Reiss said, since the U.S. is one of the largest donors to HIV programs worldwide.
Many countries that receive U.S. aid for HIV also have legalized abortion and the clinics and agencies that provide HIV care often offer other services that integrate sexual and reproductive health, Reiss noted.
Investigators will also report on changes over time to international investments, and how those changes are affecting domestic spending in countries where HIV is highly prevalent, Reiss told reporters.