New trends in managing HIV worldwide

In recent years, medical advances have revolutionised the way doctors treat people with HIV. In the week following World AIDS Day, the Royal Society of Medicine hosts a major international two-day conference to discuss these new therapies, and how they can be applied in developing countries as well as in the West.
Speakers at New Trends in HIV Management and Research on 7-8 December include:

Is the brain a sanctuary for the HIV virus?
Dr Ned Sacktor Johns Hopkins University, USA - CNS Penetration - pathological & clinical considerations
Despite improvements in treatment, about 15-20% of patients with advanced HIV infection will develop dementia. Why? Dr Sacktor's research indicates that many antiretroviral drugs are not actually entering the central nervous system (CNS) to tackle the virus. He will explain which drugs are best at penetrating this barrier, and warn that doctors should include at least one of these in any treatment programme.

How many HIV positive people are still having unprotected sex?
Dr Simon Barton Chelsea & Westminster Hospital - Sexual health in controlled treated HIV patients
Dr Barton will be summarising new data from the Chelsea & Westminster Hospital on the sexual behaviour of Londoners who know they are HIV positive. He will suggest how clinical services might be better co-ordinated to reduce what he calls "alarmingly high levels of sexual risk taking." He will warn that these are "leading to the acquisition of further sexually transmitted infections and may be further transmitting HIV infection in the community".

Treatments that could save lives 'immediately' in the developing world
Dr Richard Chaisson Johns Hopkins University - Prevention of infections around HIV in developing countries
Developing countries may not have the resources to take advantage of new antiretroviral therapies, but they can still reduce AIDS-associated mortality, Dr Chaisson will argue. Tuberculosis is the leading cause of HIV-related death in developing countries, but TB treatment to prevent the disease is relatively simple, effective and very cheap - more widespread use "will save lives in the developing world immediately". He will explain how prevention strategies for infections like TB and bacterial infections might be implemented, and how these strategies could help build the infrastructure and expertise needed to make antiretroviral treatments more feasible in these countries in the future.

Mother-child transmission: preventative drugs are available but not used
Dr Laura Guay Johns Hopkins University - Interventions in Pregnancy and Infants
Antiretroviral therapy can actually prevent a mother passing the HIV virus to her unborn child. In places like the US with widespread use of antiretroviral therapy in pregnancy, the transmission rate has fallen to less than 4%. However, there has been little change in the developing world, despite the offer of free drug regimens, due to lack of implementation of HIV counselling, testing, and drug access programmes. Dr Guay, reporting on recent advances in simpler, cheaper treatments, including results of her work in Uganda, will discuss the reasons behind the high mother-foetus transmission rates there, and emphasise how these results could be improved if existing regimens were more widely implemented.

Controlling the epidemic - are we targeting the wrong people?
Dr Thomas Quinn Johns Hopkins University - Viral Load as a Predictor of Heterosexual Transmission
Safe-sex campaigns and vaccine research have so far tended to concentrate on people who have not yet been infected with HIV. Dr Quinn will argue that if we want to control the epidemic, we should target individuals who are already HIV positive. His research in Uganda has focused on the impact of lowering viral load in infected individuals, a key factor in reducing the risk of transmitting the infection. Results suggest that this could have a "significant impact" on limiting the spread of the epidemic. He will also argue that more should be done to introduce intensive safer-sex education for infected individuals, not just those who are HIV negative.

Getting doctors - as well as patients - to stick to treatment guidelines
Dr Lorraine Sherr Royal Free/UCL Medical School - Initiation & adherence to antiretroviral therapies
For the new antiretroviral therapies to be effective, complex treatment regimens must be followed carefully. Studies so far have concentrated on why patients have difficulty with this, but Dr Sherr points out that doctors, and the treatments themselves, are part of the problem too. She will explain why she thinks doctors should look at their own adherence behaviour; whether they are genuinely following protocols and guidelines, and prescribing accurately. She will discuss recent research on adherence issues, and how HIV drugs might be improved to encourage people to use them more effectively.

Increasing impact of HIV infection & unknown epidemiology of other STIs
Dr Angus Nicoll Public Health Laboratory Service Communicable Disease Surveillance Centre (PHLS) - Emerging Trends of STDs and HIV in UK and Europe
The PHLS has estimated that by in 3 years there will be 29000 people living with an HIV diagnosis in England and Wales, an increase of around 40% from the end of 1999. Dr Nicoll will discuss how this rise will have an impact on the economy as well as on the health of society, as these infections are expensive to treat: "It is vital that prevention messages are put across effectively, in particular to a new generation of sexually active young people". Similar trends are likely to be taking place in other parts of Europe, and Dr Nicoll will emphasise that as well as maintaining excellent surveillance of HIV; we must not neglect other STIs like gonorrhoea and chlamydia. These are curable, but if left untreated they can have serious long-term complications such as infertility. Comparatively little is known of trends for STIs in Europe. Dr Nicoll argues that there is "a huge public health need for improving the surveillance of STIs and antimicrobial resistance amongst these infections... this should be a public health priority alongside managing the HIV epidemic."

[ends]