Highlights from CROI 2009

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This article originally appeared in HIV & AIDS treatment in practice, an email newsletter for healthcare workers and community-based organisations in resource-limited settings published by NAM between 2003 and 2014.
This article is more than 16 years old.

This edition of HATIP is devoted to news headlines from last week’s Sixteenth Conference on Retroviruses and Opportunistic Infections, held in Montréal, Canada. We published comprehensive news coverage from this conference at aidsmap.com.

CROI is one of the major HIV-related scientific meetings of the year, and many of the most important presentations at this year’s conference were of research conducted in Africa and Asia that will be directly relevant to the care of people with HIV and prevention of HIV infection in those settings.

This bulletin divided into five sections, each highlighting the major studies presented in those areas at the conference. Of particular note are the following:

  • Opportunistic infection management and prophylaxis: a large randomised study demonstrated that prophylaxis with fluconazole reduced the risk of cryptococcal meningitis in people with advanced HIV disease, while another study showed that use of the steroid prednisone improved the outcomes of people with TB-related immune reconstitution inflammatory syndrome (IRIS).
  • Antiretroviral treatment reduced the risk of HIV transmission within HIV-discordant partnerships in two separate studies in Uganda, Rwanda and Zambia.
  • The first evidence of microbicide effectiveness, from the HPTN 035 study, showing that PRO2000 reduced the risk of HIV infection by around 30%. Results of another major study, due to finish by the end of 2009, are awaited in order to confirm this result.
  • Late treatment initiation in resource-limited settings continues to confer an increased risk of death for years afterwards, due to the prolonged period individuals spend with very low CD4 counts.
  • Antiretroviral treatment for mothers during the breastfeeding period reduces the risk of HIV after a 14 week course of prophylaxis for the infant is stopped – but only in mothers with a CD4 count below 250 cells/mm3. Is infant prophylaxis the better tool for preventing transmission during breastfeeding? Some experts at CROI said yes, but others would prefer to give ART to mothers.

Glossary

discordant

A serodiscordant couple is one in which one partner has HIV and the other has not. Many people dislike this word as it implies disagreement or conflict. Alternative terms include mixed status, magnetic or serodifferent.

oral

Refers to the mouth, for example a medicine taken by mouth.

microbicide

A product (such as a gel or cream) that is being tested in HIV prevention research. It could be applied topically to genital surfaces to prevent or reduce the transmission of HIV during sexual intercourse. Microbicides might also take other forms, including films, suppositories, and slow-releasing sponges or vaginal rings.

immune reconstitution inflammatory syndrome (IRIS)

A collection of inflammatory disorders associated with paradoxical worsening (due to the ‘waking’ and improvement of the immune system) of pre-existing infectious processes following the initiation of antiretroviral therapy.

 

cryptococcosis

A type of fungal infection usually affecting the membrane around the brain, causing meningitis. It can also affect the lungs and chest.

All the summaries link to news reports published at aidsmap.com. You can view all symposia and oral research presentations from the conference online at the conference website http://www.retroconference.org/2009 (although we have not tested the feasibility of doing this over a dial-up internet connection and would note that even over a high-speed broadband connection it can take several minutes for presentations to load). You can also browse the conference programme online and view pdf versions of the vast majority of posters presented.

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