AIDS Conference Shines Spotlight on Asian Epidemic

October 2004—The largest international AIDS conference of all time drew more than 17,000 health professionals, scientists, government officials, advocates, and activists in the fight against HIV/AIDS to Bangkok, 11–16 July.

On the opening night of the conference, activists marched in support of expanded distribution of generic antiretrovirals and in opposition to the U.S. administration’s slow acceptance of generics as well as its focus on abstinence-only prevention programs.

While short on reports of new scientific advances, the conference, whose theme was “Access for All,” focused worldwide attention on the need for massive expansion of HIV/AIDS treatment programs in the developing world.

TREAT Asia data reported 

The TREAT Asia HIV Observational Database (TAHOD) was the focus of a 13 July satellite symposium at the conference. Data were presented from close to 2,000 patients enrolled at 11 TREAT Asia sites. Dr. N. Kumarasamy, medical officer and clinical researcher at the YRG Centre for AIDS Research and Education (YRG CARE) in Chennai, India, explained themeth-odology of the database and Dr. Adeeba Kamarulzaman, head of the infectious diseases unit at the University of Malaya Medical Center, reported on the database findings.

Seventy-two percent of the participants were male, with an average age of 36, said Dr. Kamarulzaman. Most of the patients had been infected with HIV through heterosexual contact. The most common opportunistic infections were tuberculosis and pneumocystis carinii pneumonia (PCP). Sixty-eight percent of people were on triple therapy, while the remainder were on mono- or dual therapy, or were not being treated at all.

In terms of response to therapy, the mean gain in CD4 count was 115 cells over the course of six months. Persons who entered the study with higher CD4 counts showed smaller increases. Almost 70 percent of individuals were able to suppress their viral loads to an undetectable level.

An observational database can have important advantages in assessing the progress of antiretroviral therapy programs, reported Dr. Jens Lundgren, director of the Copenhagen HIV Programme. “Although only randomized trials can reliably define the risk to benefit ratio of antiretroviral therapy,” he said, “they have certain limits that observational studies can help address.” For instance, observational studies can identify the complications from therapy that vary in different parts of the world, as well as the impact of nutritional and social factors on response to treatment. “They are a key source of data,” Dr. Lundgren said, “and should be established wherever antiretroviral therapy is implemented.”

TAHOD expansion 

TAHOD will continue to enroll patients, according to principal investigator Dr. Kumarasamy. He hopes that the database, which currently includes data from China, Hong Kong, India, Malaysia, the Philippines, Singapore, Taiwan, and Thailand, will expand to Indonesia, Viet Nam, and Japan.

Kevin Frost, director of TREAT Asia and amfAR vice president for clinical research and prevention programs, reviewed TREAT Asia’s goals and objectives, and GlaxoSmithKline Medical Director Dr. Jan Sabbat discussed Glaxo’s Positive Action program, which has awarded a grant to TREAT Asia.

The XVI International AIDS Conference will be held in Toronto in 2006.