Beyond the AIDS Conference Hype

by Brian Smith

I don't normally get that involved with cutting edge reports from the HIV scientific front lines. If my treatment is working, I am happy to leave the details to the experts. But the mainstream press from this year's AIDS convention in Geneva was downright disturbing. Who can forget headlines screaming: "AIDS Discovery Worries Scientists - Man infected with drug-resistant strain of HIV;" "Warnings From World AIDS Meeting;" "Poor Nations Losing Battle Against AIDS."

Since Project Inform fields over 40,000 hotline calls a year from across the nation, I figured they could cut through the hype. Between PI's Founding Director, Martin Delaney and the questions of the treatment-ese fluent San Francisco crowd, I learned that things are neither as bad or as good as we had been told by the media. Most of the recent coverage on the status of AIDS and HIV research has overplayed findings, latched onto peripheral issues, or published pharmaceutical press hype before checking with the experts. For my money, I'll go with what I learned that night over any big newspaper version.

Such disparity was chillingly brought home to conference participants in Geneva, in the form of ostentatious displays of wealth by the drug companies. "For the doctors from poor nations, the dinners, the shows and the food being sponsored by these companies was insulting and they became angry," said Delaney. "Something needs to be done about this before the next conference, which will be held in Africa. The pharmaceutical companies cannot behave this way again."

On the research front, Delaney said, "The one picture that is so clear from the conference is the need for a vaccine. We are never going to be able, in my view, to deliver therapy as we know it, to the hardest hit places on this planet for HIV disease. As activists, we need to focus more attention on vaccine development programs."

Back in the First World, evidence is accumulating of long-term side effects for some people using combination therapies currently on the market. This conference also confirmed long-held scientific theories on transmission of resistant virus. A report was presented in which a newly infected, untreated man was already resistant to most AIDS drugs. Meanwhile, the two-to-three year pipeline for new drugs looks weak.

In the developed countries, HIV infections continue to punish communities of color, the poor and IV drug users. Prevention programs are still woefully under-funded worldwide and despite scientific proof of its value, needle exchange funding faces an uphill battle in the U.S., after being dragged into politics.

Many studies delivered at the conference found creative and effective new drug combinations. People who have developed resistance to an older drug combination and those just starting a treatment should be able to access these regimes soon. There is no evidence, however, that suggests it's smart to switch from your current treatment if it is working well and you are not having debilitating side effects.

According to Delaney, a reporter on the East Coast surveyed the nation's clinics and found 10 people who, under medical supervision, have gone off therapy and gone six months or more without a return of replicating virus. The virus however, was not eliminated entirely. These studies suggest remission without eradication may be possible. "The debate has now become -- can people live a normal lifetime with these reduced levels and not see an aggressive return of measurable viral loads," said Delaney.

On a final hopeful note, a team from France found CD4 counts rising steadily and without plateau in patients who responded well to drugs and kept a strict regime. This suggests the immune system may be able to rebuild itself over time.

As I left this year's Town Meeting in San Francisco, my head spun with information and numbers. I had the feeling of surviving an organic chemistry lecture in college. The presentation was concise, informative, and empowering -- not surprising for an annual road show now in its second decade.

Walking through the nightime summer fog to the bus stop, I was most struck by the Third World situation. Beyond questions of how to save as many people as possible, I wondered who will buy a billion beeping watches?