International AIDS Pre-conference 2016: Saturday July 16th

Today, is the first day of a 2 day pre-conference and we get up at 6.45am. After breakfast Rolande, Prakash and I jump straight into a Heavenly Shuttle which takes us to the ICC for R80 (£5).  Each time you enter this place you and your bags have to go through a security check.Scanned just like at the airports. I thought I'd seen the last of that for a few days lol.
The pre-conference is intense and there a many concurrent sessions going on and lots of choice of different topics within the HIV field. Before attending delegates must register online for a maximum of 3 areas. This strikes me as strange as they are all happening at once and it is impossible to be in 3 places at the same time. They fill to capacity quickly and I found that the most 'scientific' ones had already been filled, but I found one which I am very happy to attend as it is what we all want and will update me on the latest info. Namely 'Towards an HIV cure'.

The pre-conference and the conference itself are composed of talks, poster sessions, workshops, poetry readings, film screening, networking opportunities and so much more. As each delegate can choose what to attend, everybodys conference and experience will be different, so if you are interested, I encourage you to seek out the blogs and reviews of other attendees and see what they did and learned. The premutations are endless........
So, the first session of 'Towards an HIV cure' began at 9am and I got in easily as I had preregistered.  Rolande was not so organised and it took some time for her to appear. I have learned that she knows how to get herself into places and to get things done. As we were to do for most sessions, we sat on the second row. This session was introduced by the co-founder of the HIV and Nobel laureate Francois Barre-Sinoussi herself! She defined HIV cure and said the main priority in science these days is getting papers published but this shouldn't be the case. She is right.

On each of our seats was a green and a red card for us each to hold up if we agree or disagree with some statements we were given to think about by the next distinguished speaker Anna Laura Ross. Firstly she asked if community was an active part of the HIV cure. Without hesitation I held up my green card and saw that Rolande and many others near us had put up a red card. No rights or wrongs but not all communities are involved in this. I hadn't thought of that so maybe I won't be so hasty next time. Then she said 'a cure is an essential part of ending the epidemic'. I was happy to be in agreement with the majority as I put my red card in the air. No, a cure and ending an epidemic are not the same things at all. Finally, she said 'curing HIV will end stigma'. Red cards. Wouldn't that be great though? This session ended with us being asked to think about what it meant to be HIV cured and what the legal implications of this would be. This was a nice gentle and interesting start which took us to 9.30am when the second session began. This consisted of 3 presentations on the basics of the science behind an HIV cure.
First up was Asier Saez-Cirion talking about the hurdles to an HIV cure.

The virus can persist undetected in lymph nodes. Also one thing I never think about but makes sense is that the virus is found in tissues as well such as the brain and lungs, it isn't just in the fluids. The HIV virus works by integrating itself into the genetic information which then forms part of an 'HIV reservoir'. Whilst viral multiplication can be stopped there is (as of yet?) no way to get rid  of this reservoir. The virus can be followed using animal models and the virus also persists due to infected memory cells. Two strategies have been deveopled to deal with this. Eradication which doesn't mean a person is protected, and control of HIV-1 infection. Early treatment seems to  favour this. An interesting Q & A followed. The second talk was given by Sharon Lewin and Gus Cairns  about current strategies and ongoing clinical trials. This retrovirus fools the immune system and one option is to make HIV invisible so that the immune system never sees it. This is difficult to achieve for a lifetime. Another major problem is that this virus comes back very quickly within weeks if antiretroviral therapy (ART) is stopped. The 2 Boston patients were mentioned, they had been in remission for just a few months. The Mississippi baby was clear of HIV for 28 months. This viral rebound as it is known, is not understood. The Berlin patient is very rare and unusual indeed. Two main strategies for dealing with this are decreasing the persistance of the virus which will increase immunity, and trying to shock the virus for latent infections. This has progressed to clinical trials but shocking alone doesn't work. Possible to enhance immunity using T cell  vaccines and there are alot of new ones. Also gene editing 'CRISPR'.The last presentation of this session was given by Judith Auerbach and David Evans talking about integrating social reseach into HIV cure. The key areas here are the stakeholder perspectives i.e. patients, clinicians, policy makers. Also the public understanding of science,  access and equity, and HIV identities. The morning ended with a quick talk at noon by Kevin Osborne, Advocating an HIV cure. He talked about what is needed and what isn't. What is happening and what isn't.
There were lots of similar looking eatery stalls scattered outside around the venue. What a great place! Rolande and I went to one of them and found a table where we could acquaint ourselves with whoever wanted to join us. It was suddenly very windy. I have a large chicken pasta salad which I really enjoy and a bottle of water I had brought with me. Again not expensive, at R35 my food cost less than £2. Prakash found and joined us and started talking about his work. A cure for HIV involving mercury? I tell people about The Rutger Hauer Starfish Association the AIDS non-profit which has a firm grasp on my heartstrings and I show them my now very tatty leaflet which I got from a fundraiser back in 2012.
The afternoon session begins at 2pm and takes place in the same room (5). There were 3 introductory speakers, firstly Jack Whitesciver then the President of the National AIDS Society Dr Chris Beyrer who tells us there are alot of femail speakers at this conference and they had over 7000 abstracts submitted! Then Barre-Sinoussi speaks and tells us that the 1st AIDS Symposium was in Vienna in 2010. Incidently this is the second time this conference has taken place here in Durban, the first time as 16 years ago in 2000. Next Sharon Lewin introduces the first speaker, none other than Dr Anthony Fauci of NIH who talks about the challenges persistant in HIV research. His lab recently used transfer of monoclonal antibodies on an exploratory study of 30 people with chronic HIV infection. They all rebounded no matter what.

The next steps  are eradication vs sustained remission. This involves state of the art gene editing techniques such as the aforementioned CRISPR. There is also passive infusion of combinations of 3 or more long lasting antibodies. 


  

Next up was a South African speaker Gethwana Mahlase talking about movng towards an AIDS cure involving community. She has her own NGO and said that the introduction of ARV's means taking 1 pill a day and alot of people forget. She spoke of there being 10 funerals a week in her community. The way forward is more research, effective drugs, community work and meaningful partnerships.
The next session started at 3pm and Dianne Rauch introduced a british speaker Andrew Phillips from UCL who spoke about identifying the key drivers of the impact of HIV cure intervention in sub-saharan Africa.

This was the first time during the pre-conf I had heard of the word 'cure' being replaced by 'suppression'. It won't be the last time and I like it, its more accurate.





After a coffee break a special session begins at 4.30pm. This is about paediatric HIV and there are several speakers. I find this a very emotional session and feel its my favourite one so far. Is it because its about kids? Oh so young. Two speakers introduced by Deborah Persaud. The first is Deena Gibbons from Kings College London talking about the relevance of paediatric immunology to HIV persistance.

  

Next up was Nigel Klein of UCL talking about the comparison of babies and adults. Over the age of 5 years old, the capacity to generate CD4 count diminishes. Overall conclusion here is that infants have a

 better immune response. 

An amazing table discussion begins at 5pm with a diverse range of people and very interesting topics. I find this a powerful session too. They include Paolo Rossi of Rome who chats about why childrens model is essential to advancing HIV, Caroline Tenneson who speaks of mother to child transmission. This was moderated by Jintanat Ananworanich from the US military HIV program. I was very touched here by a south african lady called Barbara Kinsley. She has been HIV+ for 16 years and was in denial for the first 8 years but had to face up to it when she got sick. She got better once on ARV's and started running. She is now an activist and an ultramarathoner. Her message was that we need to take care of pregnant women as no infant should be born with HIV. Positive reinforcement is needed. Maybe I was moved because she is a fellow runner who cares about the same subject. Two things in common at least. She spoke beautifully and the Q & A was also great. Todays sessions all took place in session room 5 on the ground floor in the middle of the building. We were somewhat bemused by a pigeon who kept putting in an appearance appearing from the rafters but never flying over the audience. He just hovered above the speakers. I think he has something to say or wanted to ask a question.

It is now 6pm and there is a poster and networking session at the front of the room which will go on all night. 

A nice french lady spoke to me whilst I was admiring her poster and told me she was speaking at 2 sessions this week. She spent ages telling me about her poster/research. Alas I wish I had taken a photo of it and can't think now why I didn't.







There was a wide variety of food available which waiters brought around for us. I was still full from lunch but it looked so good I eat anyway. There was a variety of alcohol available which my colleagues enjoyed and I had one can of Castle beer which I made last all evening.Sometimes not being aable to tolerate booze is a bummer!  This was a lively fun session, being able to mingle, meet and chat to likeminded people and exchange business cards and stories etc. Rolande certainly took advantage of everything on offer and it was good to see her enjoying herself. I kept wandering around to look at posters, meet new people and stretch my legs. Plenty of great people stopped off at our table to say hello.  I wish I could recall the name of the jolly kenyan guy we chatted to. Sorry dude.

L to R:Kenyan delegate, Rolande, me and Prakash

There are lots of lovely volunteers here who have come from far and wide. Tonight Rolande and I befriended a lovely botzwanan called Katie. We would see her working at the conference and when she had time she would come and seek us out bless her heart! I love anyone who loves hugs too. We were the last to leave and got a taxi back to our lodge. We got there at 8.30am. I was surprised to see puddles on the floor as a sign that it had been raining. Time to recharge out phones and laptops and catch up with emails etc. Amazing where the hours go. We had coffee and watched abit of tv before recharging our own batteries at midnight. It rained all night too xxx