International AIDS Society (IAS) Conference – Day 2

The venue for the 2011 International AIDS Society Conference is Rome’s music auditorium.  There are four main music halls being used simultaneously to host main sessions.  Delegates sit in acoustically optimized rooms as though they were attending a symphony or ballet, but the music and dancing on the stages is being carried out by the international leaders in HIV/AIDS research and clinical practice.  After the Day 1 festivities, the conference is in full swing and the venue is abuzz with science.

The plenary sessions each day set the stage for the future conference sessions.  Monday’s plenary session featured three presentations; 1) looking at the current state of vaccine development, 2) managing treatment of HIV/AIDS in 2011 and 3) using combination therapies for prevention.

An HIV vaccine is still a ways off and there are no known broad anti-viral, long lasting disabling antibodies that can be used for a vaccine. However, there have been exciting advances resulting from structural vaccinology research to determine new directions for vaccine development.  Concerning current management of HIV treatment, there has been an interesting cycle in the clinical arena regarding when to start antiretroviral (ARV) treatment. In 1996 it was recommended that ARV therapy be started when CD4 levels drop below 500 cells/ul.  In 2000 it was recommended that treatment not be initiated unless CD4 levels were below 200 cell/ul.  Then in 2008, The World Health Organization (WHO) raised the CD4 treatment threshold to 350 cells/ul and in 2009 clinicians began treating even earlier (at 500 cells/ul) with great results.

So, we have come full circle and today clinicians recommend following the original 1996 guidelines for when to start ARV treatment.  Finally, for the first time since HIV was discovered 30 years ago, the science community is discussing disease prevention, not treatment, not avoidance through behavioral change, but biomedical prevention.

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