The 2012 Canadian Association for HIV Research (CAHR) conference held in Montreal brought together researchers, physicians and community members from Canada and abroad under the theme “A Turning Point in the Fight against HIV: Meeting New Challenges.” With the advent of effective antiretroviral drugs, Canadians are now living longer with the virus. However, as HIV infection becomes more of a chronic illness there are new challenges to overcome. Presenters at this year’s conference discussed the most up to date primary research in the Basic Science, Clinical Science, Epidemiology and Public Health and Social Science streams while community members discussed their experiences on the ground working with communities affected by HIV.
2012 Mark Weinberg Lecture: Dr. Kenneth Rosenthal
Dr. Kenneth Rosenthal, as this year’s Mark Weinberg Lecturer, discussed the “Riddle of the HIV Resistant Sex Worker”. Several years ago, in Nairobi, monitoring of sex workers for infection with HIV revealed that some women appeared to be resistant to HIV. Despite high levels of exposure, they remained uninfected. Dr. Rosenthal discussed the critical role of mucosal immunity, and the apparent low level immune reaction to HIV virions in HIV resistant sex workers versus susceptible individuals. Research in primates has shown that a key factor in non-pathogenic SIV (simian immunodeficiency virus) infection is the control of an excessive immune reaction shortly after infection. It appears that the same thing is happening in resistant sex workers; cervical mononuclear cells show significantly reduced expression, leading to a lower immune response. Dr. Rosenthal discussed the implications of these findings on vaccine development. CAHR bestows the honor of the Mark Wainberg lecturer to both honour Dr. Wainberg’s ongoing contributions and to recognize the efforts of others in the research community who exemplify the same traits of excellence, perseverance, and commitment to the cause of finding innovative and ground breaking ways to address the epidemic.
Basic Science, Clinical Science, Epidemiology and Public Health and Social Sciences Plenaries
In the Basic Science plenary, Dr. Thomas Hope presented his research into HIV penetration of the cervical mucosal membranes. Using labeled HIV virions and donated tissue, his research has investigated the movement of the virus across the mucosal membrane of the cervix. He argues that virions can in fact breach the second epithelial (columnar) layer to access target cells below. During an inflammatory response, immune target cells are brought to the surface and may come into contact with HIV virions. However, Dr. Hope mentioned that the epithelial layer combined with cervical mucus still for a strong defence, and likely only let in less than 20 virions per exposure; a quantity he asserts is a realistic number to target for prevention of infection.
The Clinical Sciences plenary titled “NeuroAIDS – A View from the Clinic and Laboratory” was presented by Dr. Christopher Power. He discussed the complicated landscape of HIV associated neurocognitive disorders (HAND) and explained what current research tells us about how the viral proteins affect neurons or the immune system itself. He discussed the complex clinical manifestations of neurological problems, emphasizing that the treatment of HAND should be multifaceted. Dr. Power pointed out the importance of discussing neurological symptoms with patients and treating them appropriately, as neurological complications are indicators of infection course.
Dr. Rosanna Peeling, in the Epidemiology and Public Health plenary, discussed diagnostics and their critical role in the treatment and prevention of HIV/AIDS in developing countries. She covered emerging technologies and how they have become faster, more efficient and cost effective. However, Dr. Peeling also outlined the many barriers that exist to getting these technologies into the areas that need them the most. The cost of licensing in each country, the availability of cheap (and less accurate) tests, the politics and priorities of countries, and regulation (or lack thereof) of diagnostic devices were among the difficulties she discussed. Despite these issues, she emphasized the importance of diagnostics and how they should be assessed for utility in each country. When appropriately used, they can refine the treatment regimen, promote prevention and spread, and as a result are ultimately cost effective.
Bruno Spire’s presentation in the Social Sciences Plenary echoed the theme of the conference as he discussed the future of the HIV epidemic and the role of social sciences. He pointed out that much of the effort and research focus has been on treatment and prevention, yet these strategies are as complex as human nature. Spire argued that ending the epidemic isn’t a debate between medicinal and behavioural strategies. He stated that all strategies are behavioural and must take into account human nature and desires. For instance, prevention methods don’t work for everyone; fidelity, condom use and abstinence are not always reasonable expectations across a population. Though anti-retroviral therapy is successful at reducing transmission, not everyone gets treatment, wants treatment, stays on treatment or is treated early enough to reduce transmission. Spire pointed out that in many cases, communities such as drug users or MSM (men having sex with men) are not included in the discussions or may be missed during treatment and prevention campaigns. He asserted that in order to truly make an impact, communities affected by HIV need to be involved so that they can take ownership of the strategies. Ownership can improve participation of individuals, reach a broader group of people and ultimately increase the efficacy of treatment and prevention efforts.
In the “Roundtable Discussion on the Origins of HIV Transmission”, Dr. Jacques Pepin discussed the perfect storm in Leopoldville, the location where the HIV virus was able to flourish, diversify and ultimately spread. He argued that initially, sex work itself was not enough to spread HIV, it only served to maintain it in the population. It was the ensuing political unrest, poverty and multiple treatments (using unsterilized equipment) for syphilis that resulted in an expansion of HIV from Leopoldville (at that point Kinshasa) to surrounding areas. In support of this, Dr. Pepin presented research on increased HIV and Hepatitis infections associated with colonial era campaigns against tuberculosis, malaria and sleeping sickness. After Dr. Pepin’s historical talk, Dr. Wainberg shared his thoughts on the current and future status of the HIV epidemic and whether it has peaked. In North America, drug sensitive wild type transmission has likely peaked due to interventions. But Dr. Wainberg explained that on an international level, there are more people becoming infected than can gain access to therapy. He also emphasized that HIV is a retrovirus and can recombine with unpredictable effects. These aspects, combined with increasing instances of drug resistance, gave him cause for concern about the future of the epidemic.
Dr. Peter Ford, winner of the 2012 CAHR Red Ribbon award, discussed his work with HIV positive prisoners in the Canadian corrections system for the closing session. Prisons are a significant reservoir for HIV and HCV infections but as Ford points out, for as many prisoners that know they are HIV positive, there are an equal number that don’t know or don’t disclose. He discussed the many complexities and difficulties of working within prisons; mental health, drug abuse, co-infections, repeated parole and imprisonment all complicate treatment and prevention strategies. Dr. Ford discussed some of the evidence that HIV and Hepatitis are spread within prisons through contaminated and homemade syringes. He emphasized that treating for HIV is impossible unless the issue of drug addiction and contaminated needles is addressed. Discussion followed with panelists Richard Elliot, Kathleen Myers Griffin, and Diane Smith-Merrill. Audience questions focused on aboriginal rights within the system, recent federal budget cuts and the omnibus crime bill, stigmatization of HIV positive prisoners, drug use within prisons and expanding prison populations.
Perspectives from the Community
In the Special Session, “Working Collaboratively Across Stakeholder Disciplinary and Geographical Boundaries to Enhance Research with and for Women and HIV in Canada”, Panelists discussed their perspectives, challenges, and considerations regarding women, girls, aboriginals and transgendered individuals coping with HIV. In particular, many of the panelists emphasized the importance of involving the communities and participants in the development of research to ultimately ensure the relevancy of results.
The CATIE Learning Institute is an organization dedicated to providing information and working with communities and people affected by HIV and HCV. At this year’s conference, members from communities across Canada were partnered with CATIE staff and assigned to a research stream (Basic, Clinical, Public Health, Social Sciences). At the end of the conference, these individuals presented, in lay language, excellent overviews of the main topics covered over the three days of the conference.
As HIV treatment becomes more effective and patients are living longer with HIV, physician-patient relationships are extending over many years. In her presentation titled “The Buzz: Effective Communication Between Healthcare Providers and Patients“, Linda Robinson discussed the importance of forging a positive and open relationship with a patient so that all symptoms can be monitored and problems addressed. With this in mind, Robinson outlined the four types of communicators and how they may interact. Patients may expect different things from an appointment (emotional support, information only etc.) and she suggests that physicians should learn and adapt to the communication style of their patient to foster a better relationship and achieve better treatment results.
The New Investigators Workshop ”Practical Advice on Planning a Pathway to Career Success in HIV Research” brought together researchers to help them plan their career path. The workshop covered funding opportunities, studentship opportunities, presentation skills, mentorship and writing skills.
The CATIE institute organized the workshop “Bridging the Gap: Communicating and Working with Healthcare Providers” to help those living with HIV learn to take ownership of their healthcare and to communicate well with their healthcare providers.
Videos from the conference are now available on our YouTube page.
CAHR 2012 Abstracts (click on the Journal Supplement below)
View CAHR 2012 Program