David Bangsberg, Abstract #7 was a thorough discussion on the impact of adherence problems in the PrEP studies. He discussed complicated issues such as how the dynamics in a relationship affects PrEP adherence. Craig Hendrix Abstract #61 was an excellent speaker and gave one of the clearest discussions on pharmacodynamics and pharmacokinetics to explain the heterogeneity of the results of all the PrEP trials I have ever heard. I would encourage people like me who sometimes get lost in these concepts to watch his webcast. He makes it simple. This, coupled with Abstract #64 given by David Glidden who discussed choosing populations for maximal impact of PrEP certainly had me thinking about how we should be framing our policies on PrEP provision. And again, if anyone is confused about concepts such as Number Needed to Treat and Population Attributable Fraction, it’s a webcast worth watching.
In my notes, I wrote “I love this talk” next to Nelly Mugo who works for the Kenya Medical Research Institute, Abstract #62. And from the reaction of the attendees, everyone else did too. She gave an inspiring talk on the field implementation of PrEP in a resource constrained setting, including the problems of vulnerable populations and the urgent need to get demonstration projects going and move to implementation. She stressed, “this is an option that does not need the negotiation of safe sex”, and we know, that this negotiation is close to impossible for vulnerable populations.
I expected to hear many data rich talks at CROI, but the inclusion of a presentation on the Community Perspective On PrEP, Abstract #63 that involved a participant talking about his experience on a trial brought a human face to the numbers that I think we all need to be reminded off from time to time.
Getting away from PrEP. The opening Bernard Fields Lecture was given by Paul Bieniasz from the Aaron Diamond AIDS Research Centre. His lecture was on host restriction factors and the struggle between virus and host genomes and how they have evolved in both populations. Being a clinician, I am constantly amazed at how scientists can manipulate viruses and host mechanisms and reminded that this is where drug development all starts.
The Plenary on Tuesday morning. Douglas Lowy Abstract #19 gave an update on HPV vaccines. It was a nice overview, but nothing really new. He did comment that Australia was the first country to have high uptake of the vaccine and that it showed a substantial reduction in HPV disease in women, but also conferred significant herd immunity, as HPV disease in men also declined (study published before vaccination commenced for boys).
Adeeba Kamarulzaman from the University of Malaysia Abstract #20, gave an excellent talk on HIV in People Who Inject Drugs (PWID, we commonly use IVDU here in Australia and I have not seen this acronym used here yet). You could hear her exasperation as she presented the number of research studies and economic evidence that show harm minimisation efforts such as Needle Syringe Programs and Opiate Substitution therapy works to reduce HIV transmission. “Do we really need another study?....I think it’s for the sceptics....”. Her view was that so long as the “War on Drugs” and the criminalisation of drug use continues in the USA, there will be little that can be done for PWID. It does not look promising, as there was a recent reversal of the lifting of the ban for federal funding for needle exchange programs in the US.