Berlin Conference Overview

The major scientific AIDS conference of 1993, the IXth
International Conference on AIDS/IVth STD World Congress, will
take place June 7-11 at the International Congress Center in
Berlin. A number of satellite meetings, organized by nonprofit
groups, pharmaceutical companies, and others, are also scheduled
at the time of the conference and during the days immediately
before and after. No one expects breakthroughs at these annual
conferences, but we do expect significant advances in a number of
fields.

It is hard to know ahead of time what will be presented at
the international conference -- which is unfortunate, because
upon registration one receives two thousand pages or more of
poorly indexed material, and there is not enough time then to
scan it to discover relevant projects and persons one should
meet, without missing ongoing events. Most of what can be
learned in advance comes through the rumor mill. Some of the
following are not confirmed; the list below includes predictions
we have heard which seem plausible.

We have no way of knowing what will be most important at the
conference. Here are some of the areas we will be watching.

* Combination antivirals. Some results of ACTG 155 (AZT
plus ddC combination, compared to each of the drugs alone) are
expected. This large, well-designed study could affect clinical
practice, depending on the results. We have no information on
what the results will be.

Naturally we will be listening for talk about "convergent
combination" antivirals (see AIDS TREATMENT NEWS #170, March 5,
1993). But there is very little human experience with this
treatment approach at this time, so no definitive information
will be available.

* Protease inhibitors. This class of antiviral has long
worked well in the laboratory, and been of great interest to
scientists. The challenge has been making these chemicals work
as drugs -- be nontoxic, water soluble, able to get to where they
are needed in the body, etc. Several pharmaceutical companies
are developing protease inhibitors, but only one, Hoffmann-La
Roche Inc., has done extensive human testing, in Europe. It's
drug is believed to be safe, but even drug experts outside the
company have no idea how well it may be working. It is rumored
that Roche will present at least a little information about this
drug in Berlin.

* Tat inhibitor. Only one company has a tat inhibitor in
human trials -- Hoffmann-La Roche again. This drug is being
tested in the U. S., and some information on antiviral activity
in humans may be released in June, after stored blood samples are
tested in a batch. Meanwhile, anecdotal reports are generally
mediocre; there has been no groundswell of enthusiasm for this
drug among people in the trial.

Tat inhibitors still remain one of the most promising
treatment possibilities. Anyone can develop them, because the
technology to do so is in the public domain. But other companies
seem to have held back their efforts to wait and see how the
Roche drug does. If it succeeds, others are likely to jump in
with tat-inhibitor products; if Roche strikes out with this
particular chemical, other companies are likely to flock the
other way and abandon the area. The public interest would be
better served by developing alternatives now, in case the Roche
drug fails for reasons specific to that particular compound,
which would not apply to other tat drugs.

There are rumors that some information about the Roche tat
inhibitor may be released at the Berlin conference.

* AZT, Concorde study. We will be watching for more
information about the controversial Concorde study, which
reported no benefit from early use of AZT in asymptomatic
patients, compared to starting AZT later (see AIDS TREATMENT NEWS
#173, April 23, 1993). This study has had little effect on
medical practice so far, partly because very little information
has been released. We do not know if a more complete analysis
will be ready in time for the Berlin meeting.

* Viral assays. More accurate and practical ways of
measuring viral activity or viral load in people would greatly
speed the discovery of better drugs and combinations. We will be
looking especially for information on quantitative PCR, on
branched DNA signal amplification for measuring HIV RNA, and on
the p24 antigen test. The latter is inexpensive and readily
available, has been improved in recent years, and is still widely
used in drug development, so it can serve as a stopgap until the
more sophisticated tests become more accessible to smaller,
community-based organizations.

* Immunological assays. Here the technical problem has been
understanding the pathogenesis of HIV disease well enough to know
what immunological measurements are important. The practical
problem has been getting funding to develop these assays, since
U. S. government support for AIDS research has been reduced, and
corporate research seldom has much interest beyond the approval
of the next product.

* Pathogenesis [how a disease develops]. Anthony Fauci, M.
D., may present a unified theory of HIV pathogenesis, an attempt
to integrate what is known from the work of many scientific
teams.

* Science overview. The well-known AIDS scientists around
the world are usually located at a crossroads of science, in
contact with leading scientists everywhere. We will be listening
both for overview or summary talks, and also for any new results
from their own laboratories.

* Alternative and traditional treatments. Here the problem
is getting funding to do research to get publicly-verifiable
data. There are sessions on alternative treatments at the
conference, especially workshop B 29, "Natural and Traditional
Medicine," scheduled for June 11 at 8:30, and a round table
discussion, "Risks and Benefits of Contemporary Natural and
Biomedical Treatment," June 9 at 11:15 (note: schedules may
change). Three satellite workshops are planned: Early
Intervention Strategies in HIV and AIDS (which will look
particularly at antioxidants), chaired by H. D. Wolfstaedter, F.
R., and scheduled for June 7 at 20:00, at Westend Hospital in
Berlin; designing Clinical Trials with NATC [Natural,
Alternative, Traditional, and Complementary] Therapies, chaired
by Prof. Dr. H. J. Shroff, scheduled for June 11 at 20.00, at
Westend Hospital; and Evaluation of Case Studies at the Community
Level, chaired by Kaiya Montaocean, Ph.D., June 8 at 11:00, in
room 10 of the conference center. A fourth satellite workshop,
Psychoneuroimmunology in AIDS, had to be canceled because there
was no funding to bring the speakers to Berlin. Check times and
locations because they may change. During the conference, you
can call Wolfstaedter's phone, 453-9328 (in Berlin), for a taped
message with current information.

On June 12th, the day after the conference, there will be a
meeting of the Natural Alternative Traditional and Complementary
Medicines Caucus of the International AIDS Society; check the
number above for time and place.

Also, AIDS TREATMENT NEWS will share a booth during the
conference with Kaiya Montaocean's organization, the Center for
Natural and Traditional Medicines, in Washington, D. C. ; the
booth is #12-133.

* Nutrition. Despite universal agreement that nutrition is
important, the problem, again, is getting it taken seriously,
since unlike pharmaceutical drugs, this field seldom moves lots
of money around. Last year's International Conference on AIDS
had more nutrition information than those before. We hope this
increasing emphasis will continue.

* Other treatments. We will also be watching for new
information on many other drugs and treatment approaches not in
the categories above.

* Changing standards of care. The most immediately
important information from the international conferences is that
which affects physicians' practical treatment decisions in the
near future. This information needs to be evaluated by
specialists in each medical field, and it may be some time after
the conference before professional consensus develops.

* International communication.

(1) In many fields of science, leading work is done using
computer communication to allow scientists around the world to
work together. (See "Doing Science on the Network," The New York
Times, May 18, 1993, "Science Times" section; often, for example,
new work appears first on bulletin boards on the Internet, well
before it is printed in journals.) AIDS has been behind other
fields in using this technology internationally, but some
projects are in operation. Cost is not the main issue, as
computer communication is usually less expensive than other
kinds.

(2) Two Global Meetings on AIDS issues are scheduled in the
conference program for Sunday at 20:00 (8 p. m.) and Friday at
14:00. Last year, these meetings served as a forum to express
different issues, but it was difficult to organize long- range,
ongoing projects with people from very different backgrounds who
had not communicated before.

(3) "Community-Based AIDS Prevention and Care in Africa:
Building on Local Initiatives," is scheduled for June 5 at 14:00
at The Hotel Penta. This meeting is funded by The Wellcome
Foundation, Ltd.; we have not seen it listed in conference
schedules. There may be many meetings like this which can be
hard to find if they are not listed in a central place.

* Activist meeting. The first activist meeting at the
Conference, organized by ACT UP/New York for activists from
around the world, is scheduled for Saturday, June 5th, at 19:00
(7:00 p. m.) at Asta Buro, at the Technical University on
Strasse des Juni 17, (off Ernst Reuter Platz, one subway stop
from the central station) behind the architecture building. This
will be a meeting place for the whole week.

* The unexpected. It is always possible that the most
important advances are ones we do not know about, or do not
recognize at first.