Retroviruses Conference: Overview, Information Available
No one major story came out of the 7th Conference on Retroviruses and Opportunistic Infections, January 30 - February 2, 2000, in San Francisco. What most caught our attention was found less in the official sessions than in private conversations: the possibility of preventing or treating many of the side effects of antiretroviral treatment, possibly including some body-shape changes, by simple nutritional strategies to protect or support the mitochondria of the body's cells--an approach which has shown partial but important success in other areas of medicine. [This potential treatment often includes L-carnitine, coenzyme Q10, and/or riboflavin (vitamin B-2); we are researching this possibility and will report on it in future issues. The emerging theory that mitochondrial toxicity from nucleoside analogs, such as d4T, AZT, and ddI, may cause or contribute to many problems, probably including some but not all of those first attributed to protease inhibitors alone, was very much discussed in the official Retroviruses conference presentations; but this conference has a strong hard-science focus, which somehow has come to imply a general lack of interest in nutritional therapies.]In both drug toxicities and strategic treatment interruption there were many presentations, but they often seemed to contradict each other, leaving people as confused as before. The different results did not necessarily mean that some were wrong; instead, there were many differences in how the studies were done, so the results could not be closely compared. (It is easy to call for standardization of definitions and research approaches--too easy, in our view, as we do not believe that is the best way forward for this research. For another approach, see "2000 Outlook," AIDS Treatment News #334, January 7, 2000.)
The abstracts, lectures, summaries, and other information that did come out of the Retroviruses conference provide an encyclopedia of current work in most aspects of mainstream HIV/AIDS treatment. Here is a short guide to finding the information you need.
Official Conference Site
The official conference Web site, http://www.retroconference.org, is working smoothly, without technical problems--which is unusual for complex sites. Anyone can use this information without charge, and no registration is required.
Searching the abstracts. A way to learn about new developments involving a particular drug, illness, symptom, or other specific topic is to search the abstracts of the conference presentations. Click on 'Conference Abstracts'. Type in either one or two search terms (if two, use 'and' or 'or'), and click 'Search'. (For example, a search for 'ddI or didanosine' returns 40 abstracts, from the total of about 900 which are on the site.) Note that these abstracts were submitted months ahead of the conference, and have not been updated to reflect changes in the information.
Lectures and symposia. If you are not looking for specific keywords, but instead want an overview of a larger area, choose either 'Hear the Lectures' or 'Hear the Symposia' (the difference is that the lectures are by one person, while symposia have several speakers on different aspects of the topic). There are nine lectures, including "The State of HIV Vaccine Research," "Management of the HIV-Infected Pregnant Woman," "HIV Entry and Its Inhibition," and "Critical Issues in Antiretroviral Therapy." There are also nine symposia, with topics including integrase inhibitors, vaccines, hepatitis C, preventing mother-to-infant transmission, entry inhibitors, metabolic complications of antiretrovirals, epidemiology and prevention, and antiretroviral treatment failure. Some of the topics overlap; check both the lectures and the symposia to avoid missing relevant talks.
Once you select a talk and click the control to start, you hear the speaker's voice and see the slides as they are being discussed (unless slides have been withheld pending publication). You can move to a different part of the talk whenever you want. We have had no problem with a 56K modem connection, although there is a delay of a few seconds at the beginning, or if you skip to a different part of the talk. The system works on newer computers, at least Windows and Macintosh; the lectures will not be available on some computers, especially older ones. The slides are probably more legible on the screen than to most of the people in the audience at the conference itself (one reason being that on the computer screen, they are always in focus).
The posters. This year the conference has asked presenters to provide their posters on disk, if they want to do so; these posters will be made available on the site, probably starting in March. The posters are much more extensive than the abstracts, and will often include more recent information. No one knows how many will be submitted; presenters may either be afraid that journals will not publish their work if they make too much data available on the conference site, or they may be willing to publish the poster there, but not get around to preparing the disk.
What will not be on the site, or otherwise available except to those in the room at the time, are the "Slide" sessions; only their abstracts are available, and some information from conference summaries (see below). These talks (along with the posters) are where most of the new data is presented (while the lectures and symposia tend to be summaries and overviews). The slide sessions are often quite technical, and non-specialists would seldom find them useful.
Retroviruses Conference Overview by Telephone
A 75-minute overview of the 7th Conference on Retroviruses and Opportunistic Infections is available 24 hours a day without charge. Call 1-888-207-2647, and when asked for a password, enter 5371. Fast-forward and rewind functions are available.
The panelists are David Cooper, M.D. (Sydney, Australia), Michael Saag, M.D., (University of Alabama, Birmingham), Steven Deeks, M.D., (University of California, San Francisco), Karen Beckerman, M.D. (Bay Area Perinatal AIDS Center), and Steven Becker, M.D. (Pacific Horizon Medical Group).
This teleconference is supported by an educational grant from Roche Laboratories.
Online Conference Summaries and Commentaries
The sites below have extensive independent reports on the Retroviruses conference by physicians and other writers. These summaries and in-depth reports were written and reviewed quickly, usually the evening after the conference presentation. While the quality is remarkably good, readers should remember that it is impossible to be sure that no errors slipped through.
The Body, http://www.thebody.com has over 100 brief, easily readable summaries of conference presentations. These are listed in a table of contents on the Web page, organized by date and session. It's worth glancing through all the major conference topics in the list of contents--about seven pages of text when printed single spaced--because important subjects, like drug toxicity, were often covered in more than one session on different days.
Most but not all of the conference sessions are included; the ones covered tend to be those most important for clinical practice.
Medscape HIV/AIDS,
http://www.medscape.com/hiv-aidshome has in-depth reports--and optionally includes an online test for one hour of CME (Continuing Medical Education) credit for each of the four days of the conference, for "physicians, pharmacists, and other health care community members providing frontline clinical care for persons with HIV/AIDS."
Anyone can use this information, or take the test if they want to. Medscape requires registration to access most of its material, but registration is free and can be done quickly online.
There is also a search function for locating particular information anywhere in the conference coverage on this site. (But be sure to use the correct search engine; it is under "Conference Search" on the bottom of the contents page of the Retroviruses conference online summaries. The search at the upper left of the Medscape pages does not limit itself to the coverage of this conference.)
Topics include:
Day 1: Complications of antiretrovirals; drug interactions; lipodystrophy; adherence; vaccines; and epidemiology/prevention.
Day 2: HIV resistance; immune reconstitution; management of pregnant women; hepatitis B and C; metabolic complications; preventing transmission in developing countries; and opportunistic infections and malignancies.
Day 3: Treating drug-naive patients; antiretroviral failure; pathogenesis and immune response; AIDS mortality trends; neurology; HIV transmission (role of viral load, oral sex, and STDs); immunotherapy (with IL-2, interferon, and Remune); and primary HIV infection.
Day 4: Late-breaker sessions; cellular immunity; vaccines; resistance and resistance testing; fusion inhibitors; other experimental antiretrovirals; HIV-infected women; observational studies; maternal and pediatric issues; and CMV.
HIVandHepatitis.com,
http://www.hivandhepatitis.com has over 25 reports, including: adherence and directly observed antiretroviral therapy in prison; osteopenia and osteoporosis (low bone mineral density); metabolic complications of antiretroviral therapy; vaccine advances; interaction of cholesterol-lowering drugs with protease inhibitors; and many other topics. One-paragraph summaries are listed, so readers can decide what they want to read in greater depth.
NATAP, http://www.natap.org has over 20 reports, focusing mainly on protease inhibitors and other drugs. These articles are often quite technical, with more percentages, tables, and other data than explanation. It may take some looking around on the site to find the list of reports from the Retroviruses conference.
