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  10th Conference on Retroviruses and Opportunistic Infections
Boston, Mass, Feb 10-14, 2003
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Opening Plenary Session
Reported by Jules Levin
  David Ho is delivering opening introduction. He said 3900 people are attending, from 69 countries and there are over 900 abstracts presented at the conference. I estimate there are about 2500 people attending this opening plenary session tonite from 6 to 8pm and the conference opens tomorrow, Tuesday morning. The plenary is late starting because, I'm told, because Bill Cliniton was delayed at the airports flying in from Westchester.
John Coffin is delivering a talk on the process by which replication of Retroviruses occurs, and a history of evolution and transmission over the course of hundreds of years. He says a number of Retroviruses are present in our human genetic makeup and HIV is one of them. He says Retroviruses can be as old as 30 million years. What is he saying that's clinically relevant? Number of AIDS deaths: 20,000 in N America in 2002, 3 mill worldwide. In order to find effective treatment we need to understand HIV drug resistance. Drug resistant mutations are present prior to therapy. In the absence of drug these mutations are slightly deleterious. Resistant virus, with mutations, replicate less often and are less fit in terms of replicative capacity. Coffin's talk offered little new or of interest to me.
There is a dancing & singing group from Africa, the Sinikithema Choir, on stage before Bill Clinton appears.
A female group member is telling of her experiences with numerous Ois and AIDS defining illnesses. She tells of being near death, here is her briefly told story in her words.
Some say we need to address poverty, TB malnutrition, etc before giving treatment for HIV. Some say adherence is not possible in people in countries like mine. She addresses what others said for several years: it is not possible to bring effective HIV therapy to infected people in undeveloped countries like South Africa. But 10 months ago she got into pilot study offering ART. She has not been sick for 6 months. Her Cd4s have increased from <200 to 450. She said she takes AZT/3TC and efavirenz. She says she is few of one of the lucky people in South Africa. Why did she get access to treatment while her friends can't and get sick. She was fired from her job when they found out she had HIV and thus her family had no income, no electricity etc. BUT she says I'm adherent, "I have never missed a dose, ever". She says THANK YOU to the audience and researchers for the drugs and for future research. It gives us HOPE. One day we will have treatments that will save our lives. The singers sing "Tell the world that Jesus is alive". This presentation is more moving. The singers ask pleadingly for us "to give them the cure.....Jesus is a friend of mine." The Choir gets a standing ovation.
There are some interesting research papers being presented at the Conference and I look forward to an exciting meeting. One study addresses the effect of morphine on HCV replication in the test tube. Another tells of the effect of combining DDI and ribavirin. And there are many papers on lipodystrophy, metabolics, bone loss, insulin resistance/diabetes, and a few studies reporting findings from using natural interventions for body changes and metabolic abnormalities. A number of highly regarded doctors and researchers are covering the key papers and research presented here for the NATAP website. And I think NATAP will bring you many good reports of the key research and stories and themes from this conference.
Bill Clinton enters at 7:30, the keynote speaker. He gets a standing ovation. The audience showed up early to get front row seats to see Clinton. Someone commented to me that they thought Clinton appears to be taking greater public interest in AIDS since leaving audience. It now appears that th auditorium is filled with close to 4000 individuals. David Ho introduces Clinton by saying HIV/AIDS needs a global solution. "South Africa is pivotol in the struggle against AIDS......Nelson Mandela has give outstanding leadership in the fight against AIDS which is about to bear more fruit". Clinton expressed his typical humility: what can I tell this audience about HIV. Over 40 million are living with HIV, 20 million have died already.
Whole nations will be affected by the fact that most people dying from AIDS are between 20-50 years ago undermining the fabric of societies: the economies and families. He urges AIDS is not someone's else's problem. What is the UK to do with HIV-infected African immigrants. What about fast increasing numbers of diseased infected in China, Russia, India and Africa. There are increasing numbers of AIDS orphans in undeveloped countries. "How can we address other world issues if we lose our battle against AIDS..... How do we explain that we are having such problems with a preventable and potentially chronic disease: politics in part". We need a cure...an effective vaccine...AIDS is no longer a death sentence....HIV can be a chronic manageable disease...very few in Africa are getting HIV treatment...due to politics...we can do more....we know that...in 1992 people told him politicians did nothing about...." Then he told of accomplishments during his terms in office. He says AIDS should not be political issue, but it is and was during his term in office. He talked about how is now involved in HIV in the Carribbean and other undeveloped areas to build capacity. He talked about the lack of effort by politicians in some developed countries most affected by HIV and the help many of them need. He supported offering treatment in developing nations, not just prevention. Clinton did not say anything others could not or would not have said. But he has leadership qualities. He says he was wrong in not supporting needle exchange while he was in office, easy to say now. He told the audience of reasearchers, community, doctors...don't get discourage..one day AIDS will be history.
Tuesday morning at 10am to 12:30 is an oral session on new antiretrovirals for HIV treatment which includes talks on new protease inhibitors, a new class of integrase inhibitors, 3 new entry inhibitors in early stage of development, a cd4 monoclonal antibody in HIV-infected individuals, and a study of T-1249 (the sister drug to T-20) for patients vho failed T-20.