AIDS Meeting; Guarded Optimism Replaces Pessimism

The atmosphere at the 11th International Conference on AIDS held in Vancouver, Canada, could not have been more different from previous years. The gloom of the last couple of meetings has been replaced by a cautious optimism, with many opinion leaders in the field starting to discuss openly the possibility of using antiretroviral drugs in combination to create long-term non-progressive states in HIV-positive patients.

Some clinicians are even prepared to go a stage further, and discuss the possibility of eradicating this virus from a patient. Eradication was the subject of a meeting held last month and reported in the Marketletter (July 1). These ideas are still at the discussion stage and there are no hard data to back them up. However, the fact that these ideas are being discussed at all is indicative of the sea-change in opinion which has now hit the HIV research community.

Combination Therapy The reason for this optimism is the growing number of studies which show that combination therapy with two or three antiretroviral drugs can provide potent suppression of viral replication and corresponding increases in CD4 cell counts, as well as clinical benefits in terms of time to AIDS progression and survival. A great deal of attention at the meeting was devoted to finding the most rational way to use the new protease inhibitors (eg Roche's saquinavir, Abbott's ritonavir and Merck & Co's indinavir) and non-nucleoside reverse transcriptase inhibitors (Boehringer Ingelheim's nevirapine) in combination with the older nucleosides.