International Conference: Advance Overview

The VIII International Conference on AIDS, the largest AIDS
conference of 1992, will take place in Amsterdam, July 19-24,
1992. The great amount of information presented at each
year's conference is overwhelming and sometimes confusing. An
advance overview can help in understanding news reports
during the meeting itself, and in understanding the summaries
which will appear later in AIDS TREATMENT NEWS and elsewhere.

We have not yet seen the abstracts to be published at the
conference, nor the authors and titles of poster sessions.
(We urge future conferences to make this information
available in advance, so that attenders can prepare ahead to
make better use of the six busy days of the meeting.) We do
have a press backgrounder on what the conference organizers
think is some of the most important information to be
presented. In addition, we have our list of treatments and
other topics to look for.

The press backgrounder from the conference lists 13 topics,
of which three are most directly important to the readers of
AIDS TREATMENT NEWS:

"Vaccine Development and Vaccine Therapy:

Currently fifteen HIV vaccines are in clinical trials. These
include both preventive and therapeutic vaccines. Studies of
particular interest in this area include the work of Robert
Redfield (Walter Reed Hospital, USA) and of Fred Valentine
(New York University Medical Center, USA). Both studies
concern the introduction of a vaccine based on rgp 160 into
volunteers with early HIV infection and high CD4 cell counts.

In the area of vaccine development, important new work will
be presented by Abdelizsiz Benjouad and others (Institute
Pasteur, France) and Tun-Hou Lee (Harvard School of Public
Health, USA). Both studies involve removal of sugar from the
HIV molecule, a process crucial to effective vaccine therapy.

Gene Therapy:

One of the most promising and exciting areas of HIV/AIDS
research is gene therapy, an approach in which attempts are
made to use other genes to interfere with the replication of
HIV-1 and its ability to cause AIDS. Progress will be
reported in efforts by Matsuda and Essex (Harvard School of
Public Health, USA) to reduce the infectivity of HIV through
introduction of virus-specific interfering molecules, and in
efforts by Caruso and Klatzman (Hopital de la Pitie-
Salpetriere, France) to develop selective killing of HIV-
infected cells by booby-trapping them with toxic molecules.

Early AZT and Combination Antiretroviral Therapy:

In recent months, there have been conflicting reports on the
risks and benefits of early treatment with AZT. A series of
presentations will help clarify study results on this issue.
The latest evidence will also be presented for the efficacy
of combining antiretrovirals rather than treating with only
one such drug. In addition, novel approaches for rationally
using combinations to prevent the emergence of resistant
viruses will be discussed."

The other ten topics highlighted in the press backgrounder
are: Animal models; Evidence of differing transmission
efficiency by genotype; The definition of AIDS; HIV
transmission in health care settings; Genetic variations and
the epidemiology of HIV; Human rights and HIV; Women and HIV;
HIV/AIDS in the developing world; Traditional and alternative
therapies; and Global meetings.

Other Questions

Four people from AIDS TREATMENT NEWS will be at this
conference in Amsterdam. The following list (which did not
come from the conference organizers) includes some of the
questions we are using to organize our own approach to
information gathering at the meeting:

ddI: Information from an Italian study may support ddI over
AZT as initial therapy.

AZT, ddI, ddC: For the approved antivirals, the most
important question is what medical consensus is developing on
when and how to use them.

Other nucleoside analogs: We have heard generally good (but
sketchy) reports on d4T and 3TC, which are now in clinical
trials. We have heard little about FLT and other fluorinated
nucleoside analogs.

PMEA: This drug, active against both HIV and a number of
other viruses, might be important, but has received little
public attention in the U. S. Development appears to have
languished for business reasons; we have heard that a
clinical trial may start in the fall.

Tat inhibitors, protease inhibitors: We will be looking for
any information on these. Protease inhibitors, the target of
major research by pharmaceutical companies, have performed
very well in laboratory tests, but apparently are proving
difficult to turn into useful drugs.

Hypericin, NAC: We do not know whether information will be
presented at the conference.

Bitter melon: We expect some information to be presented, and
want to see how it is received.

Compound Q: Data from at least one ongoing study will be
presented.

CD8 expansion: Trials are starting now, so it may be too
early to expect much information.

Hyperimmune milk, similar antibody treatments: For some years
there have been positive reports about this potential therapy
for cryptosporidiosis. Last week a related article (although
not mentioning AIDS) appeared in the "Patents" column of The
New York Times (July 11); it concerned hyperimmune milk and
eggs, from cows and chickens which have been specially
vaccinated. Apparently such "nutriceuticals" are already
being sold in Asia. We do not know if there will be any
information at the conference.

Other treatments we will look for include passive
immunization, BI-RG, human growth hormone, itraconazole and
other new antibiotics (and new uses of old antibiotics),
HPMPC, and anti-angiogenesis drugs for KS and cancer. We are
also interested in advances in diagnostic tests and markers
of disease progression, and in international treatment
organizations and communication.

Pathogenesis -- understanding the development of HIV disease
and AIDS -- will be a major focus of attention at the
conference. A potentially important paper was published in
June 1992 in the Journal of Infectious Diseases (M. Cerici
and others, "Cell-Mediated Immune Response to Human
Immunodeficiency Virus (HIV) Type 1 in Seronegative
Homosexual Men with Recent Sexual Exposure to HIV-1"); it
reported that a few HIV-negative men had clear immunological
evidence of having been exposed to HIV, but may have either
fought off the virus, or been infected and recovered. We want
to see what new information or consensus about this report
may develop at the conference.