REPORT BACK: 8TH IAS Conference on HIV Pathogenesis, Treatment & Prevention
august 11, 2015
Prepared By: Barbara Santosuosso, CTAC Policy Researcher
Date: August 11, 2015
From July 19th to the 22nd, 2015, CTAC joined almost 6,0000 delegates from across the globe in Vancouver, British Columbia at the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention. IAS 2015, the largest scientific conference on HIV/AIDS, presented a remarkable opportunity for everyone involved in the global HIV response to gather and delve into the most recent scientific developments in research and consider how these could be implemented in service delivery and programming.
Some of the highlights of the conference included the following:
1) Vancouver Consensus Statement: At the IAS 2015 opening ceremony, an announcement was made to endorse the Vancouver Consensus Statement. The Statement calls for immediate ART initiation, access to antiretroviral therapy and pre-exposure prophylaxis (PrEP), and requests for leaders, governments, donors, clinicians and civil society to implement the scientific evidence into practice. In the Statement, the removal of laws and policies that impede access to treatment, the maximization of resources to support access, the establishment of new models of care to reach individuals who want and need access, and the development of a rights-based approach that supports treatment for all, are fundamental to ending the HIV epidemic.
2) WHO Guidelines: The WHO released its new evidence-based Consolidated Guidelines on HIV Testing Services, outlining tailored recommendations for the provision and delivery of testing services in various contexts. One of the new recommendations to increase access to testing services includes the use of rapid diagnostic tests by lay providers, known as the “test for triage” approach. One of the overarching goals of this new testing approach is to provide linkages to preventative, treatment and care services, including directing individuals with negative tests to appropriate prevention services and connecting individuals with a positive test to facilities for further testing, counselling and assessments for treatment and other health services. In order for this new testing approach to be successful, ongoing support (including mentoring and training); adequate compensation; and the development of national policies for lay providers, must be established.
The WHO also announced that updated Consolidated Guidelines on the Use of Antiretroviral Drugs are expected to be launched on December 1, 2015. A preview of these recommendations indicates ART initiation for all (regardless of CD4 count) and offering oral PrEP as an additional prevention tool for people at substantial risk of HIV (defined as >3% incidence). Furthermore, evidence to support the efficacy of integrase inhibitors in HIV viral suppression suggests starting treatment-naïve individuals on Tivicay (dolutegravir) as it has a favourable tolerability profile over Sustiva (efavirenz), and having individuals who are on a stable efavirenz-based regimen continue to stay on that course of therapy.
3) Early Treatment Initiation: At the conference, the long-anticipated final study result from the Strategic Timing of Antiretroviral Therapy (START trial) were revealed, and the evidence concludes immediate ART initiation after an HIV diagnosis drastically reduces risk of death, disease progression, and transmission. The benefits of early treatment initiation were observed in participants, regardless of race, ethnicity, age, sex or geographic region. Professor Lundgren from the University of Copenhagen, who presented the study findings, reported that HIV causes insistent damage to the immune system soon after infection, and while ART is effective in preventing immune damage, the development of future treatments that focus on the restoration of immune function are essential. 
In addition to the START trial findings, final results from the HPTN 052 study indicated no cases of HIV transmission to serodiscordant partners from HIV-positive partners when viral loads were suppressed. In the study, very few infections occurred after treatment was initiated (four cases of transmission were found just prior to treatment initiation or shortly thereafter). Results from analyses found that these transmissions occurred very early in treatment (prior to achieving an undetectable viral load) or when participants experienced treatment failure. Furthermore, findings suggest that in 37% of all transmissions, infections occurred from someone other than the primary partner enrolled in the study.
4) Pre-Expsoure Prophlyaxis (PreP): Overall, several studies found high adherence and retention with the use of Truvada for PrEP. In particular, the U.S. Demo Project of 557 gay and bisexual men and transgender women in the United States (Miami, San Francisco, and Washington) demonstrated that individuals at the highest risk of HIV had the highest levels of adherence. For example, adherence was found in 75% of participants who engaged in less frequent condomless sex and 89% of participants who engaged in condomless sex with two or more partners within the previous three months.  Another U.S. study of 200 gay and bisexual men aged 18-22 also found high levels of adherence among participants, although adherence was considerably reduced when study visits changed from a monthly to quarterly basis and among young mixed-race and black men.
5) Stigma and Discrimination: Stigma and discrimination was found to be a recurrent,significant barrier in reducing access to treatment, care and support services. Funded by USAID and PEPFAR, the Health Policy Project (HPP) released its Comprehensive Package for Reducing Stigma and Discrimination in Health Facilities, a set of best practices that could be used or adapted for stigma reduction training based on HIV status, injection drug use, sexual orientation, and gender identity. The tool provides a facilitators guide that includes a set of modules directed for different levels of health facility staff, such as managers, physicians, and non-medical health staff. The overarching goal of this package is to promote a stigma-free facility and to create a safe and empowering environment for all staff and patients.
 Baggaley, R. World Health Organization, Switzerland. Launch of the WHO Consolidated HIV Testing Services Guidelines. Presented at the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention Conference, July 19-22, 2015; Vancouver, B.C.
 Doherty, M. New Directions in the 2015 Consolidated ARV Guidelines Updated. Presented at the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention Conference, July 19-22, 2015; Vancouver, B.C.
 Apollo, T. Treatment Optimization. Presented at the 8th IAS Conference on HIV Pathogenesis, Treatment & Prevention Conference, July 19-22, 2015; Vancouver, B.C.
 Highleyman, L. START trial provides definitive evidence of the benefits of early HIV treatment. Retrieved from http://www.aidsmap.com/page/2986272/
 Alcorn, K. No HIV infections from partners with fully suppressed viral load during long term follow up of landmark treatment as prevention trial. Retrieved from http://www.aidsmap.com/page/2986223/
Cairns, G. PrEP demo project finds the people at highest HIV risk generally take PrEP most consistently. Retrieved from http://www.aidsmap.com/PrEP-demo-project-finds-the-people-at-highest-HIV-risk-generally-take-PrEP-most-consistently/page/2988203/
 Cairns, G. Gay youth PrEP study finds good retention and reasonable adherence. Retrieved from http://www.aidsmap.com/Gay-youth-PrEP-study-finds-good-retention-and-reasonable-adherence/page/2987813/
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