Lette'fr from Barcelona: l4th International AIDS Conference J Chipwete, C Chibwana From July 7th to l2th 2002, researchers, scientists, clinicians, senior government officials, representatives of non governmental organisations, AIDS activists and persons living and affected by HIV/AIDS from all over the world met for the XIV International AIDS Conference. The theme: Knowledge and Commitment for Action; the place: the beautiful and hot Spanish city of Barcelona by the Mediterranean Sea. Held at the Fira de Barcelona and at Palau St Jordi adjacent to the Olympic stadium the conference attracted over 15,000 participants with more than 10,000 posters on display. Conference programme The main goal of the conference was to ensure the translation into action of knowledge gained from scienceand experienceby meansof seventracks covering Science(Basic sciences,Clinical sciences& care, Epidemiology, Prevention science and Social science) and Action (Interventions & programme implementation and Advocacy & policy). The day kicked off with plenary lectures given by distinguished speakersat the Palau followed by track specific, per reviewed oral absffactsthroughout the day with poster presentationsand exhibitions, lectures,bridging sessions, symposia,debates,skills building and satellite workshops in between. Sound overwhelming? Exactly. One couldn't help feeling that you were missing out on important areasbeing presentedin another sessionelsewhere. Anti retroviral therapy The when, how and with what to sta.rt anti retroviral therapy (ART) in adolescentsand adults featured highly in the Clinical Sciences and care track. Treatment should be started in any patient with an AIDS defining illness (irrespective of the CD4 count) or a CD4 count ofless than 200 cells. Severalstudiespresented showed that more of those starting treatment with a CD4< 200 progressed to AIDS and death quicker than those with CD4s between 2OOand,350cells. Thus the ideal CD4 range to start patients on HAART would be between 200 and 350 cells. Treatment is unlikely to be initiated for these with CD4 counts greater than 350 unless viral load is >55 000. Non-nucleoside reversetranscriptaseinhibitors (NNRTIs) are preferred first line therapy in combination with two Nucleoside reverse transcriptase inhibitors (NRTIs). Efficacy rates for triple NRTI treatment with Abacavir, NNRTI or Protease inhibitor (PI) based were shown to be similar although the side effect profiles do differ. Thus the regimen chosen must be based on potency, side effect profile, convenience, cost, accessibility, resistance if klown and bearing in mind future treatment options. Treatment should of course be started when the patient and provider is ready to ensure maximum compliance and understanding with the primary aim being the reduction of morbidity and mortality and improvement of the client's quality of life in addition to the suppression of viral load and restoration and preservation of immunologic funcJion.There is currently no room for dual therapy and structured treatment interruption is only to be considered in researchsettings, as the current data does not show sustained control of viraemia in the majority of patients after several cycles. Treatment should be changed if there is toxicity or treatment failure. Malawi Medical Jomal

Resource limited settings The argument that ART is not feasible and is likely to be more harmful in resource-limited settings is falling away. In his addressat the closing ceremony Prof. Joep Lange, the incoming president of the International AIDS Society (IAS) questioned why we are more concernedabout side effects than people lives, why we are more keen not to do harm than to do good. The best we can provide for our patients is anti retroviral therapy and the basic minimum lab investigations necessaryare an HIV antibody test and a Haemoglobin level. A total lymphocyte count of

Letter from Barcelona: 14th International AIDS Conference.

From July 7th to 12th 2002, researchers, scientists, clinicians, senior government officials, representatives of non governmental organisations, AIDS ...
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