Updates from the International AIDS Society Conference

By Alex Ekblom | July 2, 2013

WHO's Gottfried Hirnschall at a press conference announcing new guidelines for the treatment of HIV and the prevention of mother-to-child transmission of HIV at IAS.

IAS

This week, several EGPAF team members are attending the International AIDS Society Conference (IAS 2013) in Kuala Lumpur, Malaysia. We are keeping a close eye on all of the exciting discussions and updates. See below for highlights from the conference so far!

Saturday: Pre-IAS Session: Updates from Pediatrics Meeting

The 5th International Workshop on HIV Pediatrics took place on June 28 and 29 in Kuala Lumpur, ahead of the official start of the 2013 International AIDS Society (IAS) Conference. The workshop brought together virologists, pharmacologists, pediatricians, obstetricians/gynecologists, and other interested researchers to present and discuss the latest developments in the field of HIV pediatrics, drug development, and prevention of mother-to-child transmission (PMTCT). Dr. RJ Simonds, vice president of innovation and policy at the Elizabeth Glaser Pediatric AIDS Foundation, participated in the workshop. Below, he outlines some key research presentations on the pediatric HIV/AIDS epidemic from the two-day session:

Malawi — The findings of a comparative analysis indicated that, compared to women who initiated antiretroviral therapy (ART) for their own health under guidelines which recommended that only immune-compromised women were ART-eligible,  women initiating lifelong ART under Option B+ (expanding the scope of eligibility to anyone with a HIV-positive test result) were less likely to return to the clinic for treatment, and were more likely to be lost to follow-up.

Botswana – A study following 821 children who had had in-utero antiretroviral (ARV) exposure in Botswana found that those who were exposed to ART were born significantly smaller (weight and height for age) than those who were only exposed to zidovudine (ZDV), a type of ARV.

Swaziland –  An HIV drug resistance survey of 201 HIV-infected children younger than 18 months of age in Swaziland and 232 in Zimbabwe showed that 35 percent of children in Swaziland and 63 percent of children in Zimbabwe had one or more drug resistance mutations (a prevalence of drug resistance twice as high in those exposed to ARV for PMTCT).

Thailand –  A– A national early infant diagnosis (EID) program that transports infant blood spot samples by mail to labs and returns results over the internet resulted in a shortened diagnostic turnaround time; however, only 62 percent of HIV-positive children started treatment. A relatively quick turnaround time for EID specimens tested in a central location is possible, but there are still barriers to starting children on ART.

Sunday:

On Sunday, June 30, the World Health Organization (WHO) launched new guidelines for antiretroviral therapy (ART), which call for an additional 9 million people to be eligible for ART, recommend lifelong ART for pregnant and breastfeeding women, and favor increased eligibility for children younger than five years of age. EGPAF-Kenya’s Dave Muthama reported back on two high-energy sessions focusing on the revised 2013 ART guidelines.

Through these guidelines, the WHO is recommending the implementation of a fixed-drug regimen for the treatment of HIV (TDF-3TV-EFV). This simplified regimen is a breakthrough in this field and will have a huge impact on the countries most affected by HIV, from both an access and costing perspective. The new recommendations will simplify access to ART among HIV-positive women of reproductive age, and will enhance the gains made through PMTCT programs.

It is Dave Muthama’s hope that the ministries of health will accelerate the implementation of these guidelines—the recommendations signify great progress in the effort to eliminate pediatric HIV/AIDS.

Monday:

Dr. R.J. Simonds also participated in an IAS satellite session called “Beyond Option B+,” which was sponsored by UNICEF and IAS. The session was led by Elaine Abrams, who reviewed the new WHO guidelines and the new data on treatment numbers and progress in the Global Plan in addition to sharing some country experiences. Abrams discussed the good progress being made towards reaching the goals of the Global Plan, but also touched on why some countries are slower to progress toward these goals than others. She highlighted the gap in treatment among HIV-positive children and some of the causes of that gap:  difficult and limited pediatric treatment formulations, low uptake of early infant diagnosis and slow return of results. Two panel discussions featuring WHO officials, researchers, pharmaceutical representatives, national government officials, and women living with HIV followed the session. 

Apollinaire Tiam, Technical Director of the EGPAF-Lesotho program, represented country-level implementation on the discussion panel. The panelists discussed the need for clear implementation plans for adequate supplies and workforce, specific local guidance that is feasible to implement, leadership in expanding treatment for children, and better indicators to track early initiation of HIV-positive children on treatment. When the discussion was opened to the audience, participants raised some concerns, focusing on how to ensure that women have an informed choice about which PMTCT option they will use and patent issues with new drug formulations. All in all, it was a lively session, emphasizing the need to address many issues in implementing lifelong treatment and expanded treatment guidelines for children.

Stay tuned to our blog for more news and updates from IAS 2013!