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AIDS forum down to nitty gritty after breakthrough trials

ROME, July 18, 2011 (AFP) - Buoyed by trials of drugs to prevent the spread of HIV, a global AIDS conference on Monday debated how to draft recommendations and muster funds to transform these dramatic results into action in the field.

Researchers from around the world were getting their first look at full peer-reviewed data from a trial that, say veteran campaigners, could slow the 30-year-old juggernaut of AIDS.

It was carried out among 1,763 couples where one partner was infected by the human immunodeficiency virus while the other was HIV-free.

When the infected partner was given an early start on HIV drugs, this slashed the risk of transmitting the virus to the other by 96 percent -- a figure readily comparable to the effectiveness of a condom.

Other trials, in which the non-infected partner took the drugs, found a risk reduction of up to 73 percent.

Even battle-hardened veterans in the war on AIDS are stunned.

Antiretroviral drugs which are a lifeline to millions of infected people are poised for a glittering new role, as a tool to prevent viral spread, they say.

"We are at an important tipping point," Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), told AFP.

"There is an extraordinary window of opportunity and the sooner we act on it and the more robustly we act on it, the quicker we'll achieve the goal of turning around the epidemic.

"Pure, simple math tells you that the fewer people who are infected, the fewer the people who are going to get infected. We've got to turn that knob and get it on the right trajectory."

But Fauci and others said many tasks lay ahead in safely transposing a trial, which takes place in carefully controlled conditions where couples are counselled and supported, into the messy reality of everyday life.

Reflecting the historic turn of events, the UN's World Health Organisation (WHO) on Monday scrapped plans to issue new guidelines on administering antiretrovirals, said delegates.

These will now be reviewed in the light of the latest discoveries, they said.

"People will be arguing about the next six or eight weeks about what to do, the maximum transmission benefit and the maximum treatment benefit, where do they overlap," said Myron Cohen, lead investigator of the landmark HPTN 052 trial and professor of microbiology and immunology at the University of North Carolina at Chapel Hill.

"There will be formal recommendations and there will be momentum, the two things will go in parallel."

Another question, though, is money.

After a surge in funding in the last decade, support for AIDS from rich countries has plateaued. Poorer countries are doing more, but there is still a huge gap.

Overall, around 16 billion dollars have been earmarked this year, compared to needs estimated at 22 to 24 billion dollars depending on the treatment.

Michel Kazatchkine, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, turned a worried eye to this problem.

"The priority right now is reaching people who really need treatment," he said in an interview, referring a threshold defined by current WHO guidelines as below 350 CD4 immune cells per microlitre of blood.

"There will be spectacular progress over the next five years. We will practically be reaching universal access" to people in this category, Kazatchkine told AFP.

"But putting everyone on treatment is not a prospect, either from the resource point of view or from the operational point of view. Half of the people who are infected aren't even aware of their (infection) status."

AIDS has killed around 30 million people since it was recorded as a novel disease in 1981.

More than 34 million people were living with HIV, two-thirds of them in Africa, at the end of 2010, according to UNAIDS.

The conference gathers 5,500 specialists, ranging from virologists to pharmacologists and disease trackers.

It is staged once every two years by the International AIDS Society (IAS), which also organises the International AIDS Conference, a bigger event that touches on the pandemic's many social dimensions.

 

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