The International AIDS Conference begins a week from Saturday and expectations for the meeting are mixed. This is the second in a series of interviews with leaders in the field of HIV/AIDS treatment, research and advocacy on their thoughts as the conference approaches.
Veronica Miller, PhD, is the Executive Director of the Forum for Collaborative HIV Research, now part of the University of California Berkeley where she is a visiting professor. The Forum works to advance clinical research and translate results into patient care. Professor Miller has emphasized the importance of involving all stakeholders in driving the field of HIV treatment forward. Under her leadership, the Forum has expanded to include a focus on global HIV issues. Professor Miller received her education from the University of Manitoba where she received a Bachelor’s of Science in Microbiology and a Doctor of Philosophy in Immunology. Her research interests include HIV treatment strategies, especially on the immunological and virological impact of antiretroviral drug protocols. A key area of interest is viral drug resistance and the characterization of treatment failure.
What are your expectations for the conference?
If we go back to the IAS meeting in 2002 in Barcelona, that conference really kicked off the policy discussion that there should and would be HIV treatment in the developing world. The activist community and the academic community really made that happen. That is one of the cornerstones of the development of HIV treatment programs in Africa. My point is, these meetings can have a whole lot of impact – because of the size, the media attention, the dignitaries that come, etcetera. It can do more than just provide information. It is more about sociopolitical issues than science. There is great science as well, but this is the forum where people can make big changes.
It really has a very valuable place and I think scientists and research networks should attend because then they come into this world of major civil society movements. What has become very obvious to everyone is that business as usual will not continue. We need to make some very profound changes in our approach to dealing with the global epidemic.
I believe we need to end AIDS exceptionalism. And by that I don’t mean that we end committed funding for HIV/AIDS programs, but we need to find much more effective ways of integrating what is happening with HIV/AIDS programs and the other major health programs. We can do much, much better at integrating HIV acitivities with the other global themes that are ongoing in global health such as maternal child health, family planning, other major infectious diseases, other major chronic diseases – as well as issues like drug use.
What I’m expecting will happen is that it will become another milestone in our path to making all of global health activities more efficient. And I think there will be much more attention to integrating HIV/AIDS programs into other programs. The major programs like PEPFAR and the Global Fund really see this as the only way forward.
Specifically, I expect a lot of discussion on the HIV/TB coinfection topic – and I think that’s another area that is very well-suited to help demonstrate this integration that I was mentioning before – bringing these various global health programs together in a way in which they can both benefit, instead of having one take away from the other.
Also, everyone is looking forward to the results of the CAPRISA study, which looks at the use of microbicides at preventing HIV infection.
If the results to the PrEP trials are good, what is the prospect of using this successfully, when there is very little money to expand existing treatment programs as it is?
Whenever you have the same intervention being used for both treatment and prevention, it sets a needless dichotomy – will you do one or will you do the other. I think that every case of HIV that we prevent will be so extremely valuable in terms of coming to grips with the epidemic. But we certainly cannot stop treating the people that need the treatment. Obviously we have budgets for treatment and budgets for prevention, and people will really need to continue this process and discuss why prevention would be beneficial to the community. We need to ensure that both prevention and treatment are prioritized. People will have to be very smart about how to move forward. If PrEP would be one way to really put a hold on the increasing numbers of newly infected people, then it definitely should be implemented and people should have access to that intervention.
What will your participation entail?
The Forum is co-sponsoring a symposium that will focus on better diagnosis of HIV infection in infants, along with the International AIDS Society, the Elizabeth Glaser Pediatric AIDS Foundation and many other organizations. This will be a review of the latest technologies in infant diagnosis and the need to use them in more efficient ways. It’s called “Scaling up Early Infant Diagnosis of HIV as the Bridge between Prevention, Care and Treatment” and takes place on Sunday afternoon.
We are also sponsoring a symposium entitled Review of Cardiovascular (CV) Disease Risk in Persons Living with HIV: From Statistics to the Clinic (pdf). This is the culmination of a rather lengthy program we have had that has looked at the issue of CV disease and HIV disease using statistical analysis and analytic methodologies for the appropriate analysis of observation of cohort databases. We will be condensing this into a two-hour summary, focusing on the translation of these findings for clinical management. I will be opening and moderating the first session and the participants will include experts from the field of HIV, the field of cardiology and regulatory agencies.