Experts discuss challenges at the AIDS conference

By Henry Neondo

The emergence of new antiretroviral drugs, genetic engineering and male circumcision are the latest and most promising HIV/AIDS prevention and treatment methods, delegates attending the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Australia, said yesterday.

Delegates attending the conference, which ends today, are expected to present studies and discuss advances in HIV/AIDS prevention and treatment.

The conference aims to improve understanding of HIV/AIDS, treatments for the disease and methods to prevent it from spreading worldwide.

Robert Bailey, a professor at the University of Illinois-Chicago's School of Public Health, at the conference Tuesday said studies conducted in Uganda and Kenya -- along with other studies in the U.S., Zambia and Malawi -- have found that male circumcision reduces female-to-male transmission of HIV by 60 percent.

According to Bailey, male circumcision -- which the World Health Organization and UNAIDS have recommended to help reduce transmission of the virus -- could prevent two million new HIV cases and 300,000 AIDS-related deaths in sub-Saharan Africa over 10 years.
"The challenge ahead for us is how to roll out circumcision safely ... and to persuade leaders in countries that it is going to help their populations," Bailey said.

He added, "Circumcision is not just simply a medical procedure, it's tied up in a complex web of cultural and religious practices and beliefs, so it's not easy for politicians and ministries of health to very quickly come out in favor of circumcision in countries where it's not traditionally practiced."

Bailey said leaders in developing countries need to endorse circumcision because international health authorities will not impose it because of concerns about appearing culturally insensitive. "But the time to act is right now," he said, adding,

"Delaying the roll-out of circumcision could be causing more harm, not just because more people are getting infected with HIV than necessary, but also, people are going to unqualified practitioners".

Experts at the conference say women in Africa likely will be the driving force behind male circumcision as an HIV prevention method because traditionally they are associated with ensuring hygiene in their communities. "Women, more than men, equate circumcision with improved hygiene," Bailey said.

Michel Kazatchkine -- executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- said, "I believe that the evidence is overwhelming for the efficacy of circumcision," adding, "And if countries come to us ... I see no reason at all why we wouldn't fund that."
Delegates at the conference also discussed emerging antiretrovirals, including integrase inhibitors, and techniques such as genetic engineering to treat HIV/AIDS.

Joseph Eron, professor of medicine at the University of North Carolina-Chapel Hill, at the conference said recent research has shown that new classes of antiretrovirals could offer treatment to HIV-positive people who have become resistant to first-line drugs.

"I think that while it will take some time, some of these new agents will also be very useful in the developing world where we are seeing the emergence of resistant virus," Eron said.

Experts say, human trials of a new technique of genetically modifying the blood stem cells and CD4+ T cells of people living with HIV and reintroducing the cells back into the body are about to begin.

John Rossi, head of biological sciences at the Beckman Research Institute at the City of Hope, said this technique is a "permanent modification of the cells. As long as the cells persist in the patient, they will be resistant to further infection." He added, "We realize that this is not a treatment that will be applied universally," but the treatment should allow some HIV-positive people to reduce drug doses.

Rossi and Eron also called on drug companies to make new drugs available to developing countries.

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