from Jules Levin

Friday July 4, Geneva

Several speakers were selected to deliver brief summaries. I will briefly report their presentations. My final reports will be forthcoming. The clinical section was summarized with several points by the speaker; the following is a partial list; I will report a more comprehensive review:

• the goal of therapy should be to reach less than 50 copies/ml
• at least 3 drugs should be used to reach this goal; my thoughts are that therapy needs to be individualized to the characteristics of the person in question considering their baseline viral load, previous therapy, adherence capacity, future strategies; in some cases a 4 drug regimen may be necessary to reach <50 copies/ml. In fact, <1 copy/ml is the goal of therapy as expressed by Doug Richman at December ACTG Conference
• the speaker said he found the efavirenz data "intriguing"; he sais efavirenz+AZT/3TC is "likely to change clinical practice".
• cost, adherence, toxicities, and resistance continue to be problems; he said, to hit hard and early is being tempered because of potential adverse events; I assume he is referring to the lipodystrophy or fat redistribution problems that some are saying is related to protease therapy. I say, we dont know conclusively the mechanism of these effects and if they are related to therapy, HIV, recovery from HIV or some combination of these factors. It is CRUCIAL that the researchers, pharma industry and the FDA coalesce in a concerted effort to clearly confirm the mechanism of action for this syndrome and explore a potential solution.
• the speaker said the good news is we may have inroads into the potential mechanism of action; he called for the drug companies to follow individuals clinically to beter understand the problem;

Future Goals

• timing of initiation of therapy
• goal of plasma viral load
• what is optimal potency
• validation of drug resistance tests
• definition of drug failure

A speaker in this session called for "gay white men" to give up leadership to PLWHA in developing countries. I am not sure if he is referring to the Intl Conference or in general with pharma industry. A number of leading American activists whom I spoke with found this insulting, non-productive, and potentially self-defeating. No matter what demographics we are, Americans will never diminish our role. Such a request is inflammatory and absurd. The Intl Conference leadership shows a lack of insight and vision by making such a statement. They have no idea how to gather a proper movement. They are refrring to the notion of improving treatment access and information to those in developing world.

The speaker said $36 billion would be required to supply triple therapy to all who need it. He also said, and I agree with this statement, that financial leadership from developed nations is lacking and a shameful disgrace. Governments in such countries as France, UK, Germany and in any other effected by HIV and AIDS should be spending lots more on AIDS. In 1990 AIDS was not present on the top ten list of diseases leading the world in incidence. The speaker said that by 2020 AIDS will be #9 on this list.