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The Virtual AIDS Conference: CROI Webcasts Reviewed

tagline 2009 April


Webcasts make CROI the most accessible AIDS conference of the year.


By Bob Huff

The Conference on Retroviruses and Opportunistic Infections (CROI) is the most important scientific meeting on HIV and AIDS during the year. Although attendance at CROI is highly restricted, the conference is actually one of the most accessible sources of cutting-edge information about new HIV research due to the abundance of webcasts that are presented for free on the CROI website at www.retroconference.org.

To view the webcasts, open the tab for Webcasts and Podcasts, scroll down to the session you are interested in, and select the way you would like to view the webcast (I recommend Play Audio and Slides). Once the program loads, you can jump ahead to a particular speaker by selecting the Index tab at the bottom of the viewer, then clicking on the name of a specific speaker.

While most scientific sessions will be impenetrable to nonscientists, a few selected webcasts provide an accessible and informative overview of some of the emerging and persistent challenges in HIV research. Here are a few recommended webcasts from presentations made on Sunday, February 8, 2009.

Special Presentation for Young Investigators: Revisiting the Unanswered Questions

Jon Cohen, Science magazine

Science magazine journalist Jon Cohen offers a “perspective talk” on the state of AIDS science in a special lecture for young investigators. As a nonscientist who has closely followed HIV research for over 20 years, he speaks clearly and sensibly about the most interesting unanswered scientific questions that are ripe for new research. In 1993 Cohen contacted 150 researchers and asked them to name the top ten questions standing in the way of obtaining a cure and a vaccine for HIV. It is surprising how many remain relevant today. Cohen also notes the conflicts and controversies that swirled around AIDS in the early 1990s. With no effective treatments and the death rate rising, anger, speculation, and ignorance made headlines; a feeling of doom and gloom prevailed. Then, with the breakthrough discovery that AZT could prevent transmission of HIV from mother to infant during childbirth, the tide began to turn, and Cohen details the wave of good news that followed, including the advent of effective therapy that finally tamed the death rate in the United States and Europe.

In 1993, the epidemic in Africa had not yet exploded but the signs of the coming disaster were evident. Cohen’s presentation also covers the revolution in access to therapy in Africa and elsewhere that was brought about by worldwide activism during the first few years of the new millennium. Cohen notes the contrast he observed during his travels: “I began to see activism everywhere.”

Today, the drugs are better, and treatment access in poor countries has improved, but the gaps remain daunting, as prevention efforts have failed to take root and limits in funding and infrastructure prove difficult to master. And of the top questions for scientists that existed in 1993, less than half (mainly those regarding treatment) have been answered; none of the questions about the development of a vaccine have been put to rest. For young scientists, Cohen suggests, there is no shortage of important and fascinating work yet to be done in the world of HIV and AIDS, and he concludes his talk by detailing some intriguing new developments that have appeared in the scientific literature.

Workshop for New Investigators: HIV Prevention

Susan Buchbinder, San Francisco Department of Health

In part 2 of the special session for young scientists, Susan Buchbinder provides perspectives from the world of HIV prevention, focusing on what we know about the current epidemiology—who is becoming infected and why; the opportunities to be found in the failure of several recent clinical trials for prevention technologies; and lessons for moving forward in how we learn from these failures and build on our successes.

Buchbinder discusses useful and easy to understand concepts such as “attributable risk,” and how sometimes the impact of a risk factor may not appear evident without having a deeper understanding of how people really behave. A spate of “negative” trials in the field of biomedical approaches to HIV prevention, Buchbinder notes, is actually an opportunity to understand new ways of thinking about prevention interventions. For example, a failed trial of using diaphragms to prevent HIV infection revealed that women who were assigned to the experimental intervention were less likely to protect themselves with consistent condom use, a finding that will help design how future trials are designed. The question of risk compensation is a problem for the implementation of all kinds of successful prevention technologies, from seat belts to sunblock: people will increase their levels of risk if they believe they have become invulnerable. The lesson is that interventions that combine technologies with behavioral change and education are essential if we are to realize the full gains that our discoveries promise.

Workshop for New Investigators: Complications and Opportunistic Infections

Richard Chaisson, Johns Hopkins Univ.

Dr. Chaisson begins by noting that, although the Conference on Retroviruses and Opportunistic Infections has often neglected opportunistic diseases during the past decade, the 2009 meeting features several “blockbuster” presentations on these infections. He notes the dramatic decline in deaths due to the “classic” opportunistic infections of AIDS that followed the introduction of antiretroviral (ARV) treatment in 1996. Yet people with HIV are still becoming sick and dying at a faster rate than others, primarily due to tuberculosis, viral hepatitis, and other so-called non-AIDS events involving the heart, kidneys, or liver. Antiretroviral treatment reduces the impact of these diseases but does not eliminate them. It is unknown if the non-AIDS conditions are due to permanent immune damage from HIV infection, residual immune damage, ongoing inflammation, or to longterm ARV toxicity.

Chaisson then discusses the infections that can accompany HIV, first focusing on the problem of tuberculosis in Africa. TB rates have exploded among people with HIV, and TB kills more people with HIV than any other disease. Treatment with ARVs plus TB drugs is effective—if the disease is diagnosed and the drugs are available. Viral hepatitis B infection is another emerging problem that affects 400 million people worldwide, 4 million of whom are also infected with HIV. While people with both viruses respond to ARVs, they often experience greater liver toxicity from the drugs.

These are only three of the more accessible CROI webcasts, but they cover a vast amount of terrain and open up questions that viewers are encouraged to explore through the dozens of other, more technical webcast presentations from this important conference.