CROI 2013: The Studies Most Likely to Make Waves
March 1, 2013
Take a good look, my dear. It's an historic moment you can tell your grandchildren about.
The 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013) will be held next week in Atlanta, Ga., the land of Gone With the Wind and the home of the U.S. Centers for Disease Control and Prevention (CDC). Over the past decades, CROI has been the place to learn about new drugs to treat HIV and its myriad complications.
These decades have seen many significant advances in care: A once untreatable, usually fatal infection is now controllable with medications -- and, in developed countries, the opportunistic infections that gave the conference its name are uncommon. Indeed, the menu of the conference now reflects this good fortune: It has new focus areas on topics other than AIDS and opportunistic infection.
What to expect in this year's running? Here's my short list of to-watch studies and presentations (which will be updated with links as coverage of them becomes available):
Antiretrovirals: New and Experimental Drugs
You may have heard that the HIV drug pipeline is drying up. I don't think so.
The cure agenda took big steps in the past few years, from the initial and follow-up reports on Timothy Brown (aka the "Berlin patient") and subsequent reports of a functional cure in two patients following bone marrow transplant. An additional emerging theme was the use of histone deacetylase inhibitor-based strategies to stir resting cells. At CROI 2013, we will see:
Biomedical interventions can prevent HIV. Period. But a major question remains: How do we engage the patient and provider communities in achieving an AIDS-free generation? CROI will hopefully explore this question with:
Hepatitis C (HCV) Treatment
The time has come for widespread treatment of HIV/HCV coinfection. But treatment with which agents and for how long? How to deal with nagging drug-drug interactions? CROI will explore these issues in depth with:
The Cascade: Improving Engagement in Care
Only 1 in 4 Americans living with HIV have achieved an undetectable viral load. Seems like the same is happening in other countries. What can we do about it? Hopefully some of these CROI presentations will help point a way forward.
We've reached a tipping point in the history of the HIV/AIDS pandemic. A once-fatal infection is now largely controlled with effective, well-tolerated treatments, and access to life-saving treatment is improving (though a long way from adequate). New biomedical interventions to prevent HIV infection, treatment-as-prevention approaches and pre-exposure prophylaxis have greater than 90% effectiveness in adherent individuals. Meanwhile, new treatments for HCV may cure the majority of infected individuals, and emerging data demonstrate their effectiveness in HIV-infected patients as well.
People living with HIV who have access to -- and remain adherent to -- care may have normal life expectancy. But many, perhaps a majority, of people living with HIV fail to reach this goal. The medical community must now confront difficult issues of testing, entry to (and retention in) care and an evolving spectrum of non-AIDS, often non-communicable, diseases.
Last year, my revered friend Paul Sax, M.D., opined that the name of the conference should change along with the evolving spectrum of HIV illness. I think a fitting new name, like that of Atlanta's health beacon, might be "Conference on Long Life With Retroviruses, Hepatitis and Prevention."
Benjamin Young, M.D., Ph.D., is the chief medical officer of the International Association of Providers of AIDS Care (IAPAC), one of the world's largest organizations of HIV health care providers.
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