CROI 2018: 25 years of HIV science see “precision prevention,” hopes for long-term remission, attention to TB, and more

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Science Speaks is in Boston this week, covering CROI 2018, the 25th Conference on Retroviruses and Opportunistic Infections.

BOSTON – Dr. Judith Currier, now chair of the 25th Conference on Retroviruses and Opportunistic Infections, didn’t attend the first CROI in 1993, but she remembers how things were then. A dozen years into the epidemic, AIDS was the leading cause of people in their most productive years. Care for people living with HIV meant trying to make their remaining time more comfortable and perhaps a little longer. A big debate at that first conference was whether to use AZT alone, or as part of combination therapy during pregnancy. Attendees didn’t carry smart phones then, and the laptop computers they carried weighed 15 pounds.

As Dr. Currier opened the conference Sunday, news of advances in molecular surveillance and genetic viral tracking that can identify the emergence of transmission clusters in real time, and detect patterns of infection, making “precision prevention” measures possible had already been released. A study charting the rise of infection risk during and after pregnancy pointed to more opportunities for prevention, including provision of pre-exposure prophylactic use of antiretroviral medicine — or PrEP — during pregnancy. Findings from a study of rhesus monkeys indicated opportunities to delay rebound of HIV in the absence of treatment, and hopes for inducing long-term remission of the virus.

All of the findings were the result of sustained funding over many years, Dr. Currier noted. They took time to reach, but led to tangible progress, she said, noting that with 21 million people accessing antiretroviral treatment by the end of 2017, the number of new infections is falling, as the 25th CROI opens.

But with stagnant funding and White House proposals for radical cuts to research funding, fewer young scientists are entering the field of HIV research, Dr. Currier said, adding that “while we are doing more with less, we could do more with more.”

And more remains to be done, she said. She was echoed by Dr. Elizabeth Bukusi of the Kenya Research Institute. In Kenya, Dr. Bukusi noted, HIV still is the leading killer of young people.

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