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“Any emerging infectious disease has a role at ISHEID and any advance in these issues is covered in the meeting. It is certainly the most important meeting on HIV in France. Other countries have their own national HIV meetings established for some years. This is the French meeting yet it attracts delegates from around the world.”
Now that effective therapies exist to block HIV replication Dr Soriano said that the program for 2012 would evolve to address additional topics. “If patients take the medication as directed everything works,” he said. “For HIV we now need to look at the longer side effects and safety, as well as strategies for eradication. We can treat all the patients but we cannot eradicate the disease for now.”
Dr Soriano expects that the ISHEID discussions will continue to develop in the fields of other viral diseases. “We need to establish some ideas on the best use for the new antivirals,” he advised. “Who should be treated? How should they be treated and for how long? There are side effects and drug interactions. Hepatitis is the only chronic viral disease that we can cure. Hepatitis C can be eradicated with good medication. Treatment can be provided for a short period of 6-12 months.”
This extension of conference content is also reflected in Dr Soriano’s predictions for the career development of practitioners. “An HIV doctor cannot be expected to know everything about all the associated diseases and treatments,” he said. “We are humans and we continue to be limited. With viral diseases, we will have super specialists. A doctor cannot just provide the drugs and see what happens. This is one of the main reasons for attending ISHEID. I like to hear my colleagues exercising in other areas because they address relevant advances and I learn a great deal”.
“Medicine is becoming very fascinating. The way you manage patients is so complex that you need to know many things at the specific time points, for that patient at that time. It’s very sophisticated. Fifty years ago you provided penicillin and that is all. But now there are complex concepts that help us to individualize therapy. In order to know well one disease we need to decide which one to focus on. You cannot try to cover everything.”
The research methods employed in investigating causes and treatments for HIV have also been instrumental for assisting in research into other viruses, according to Dr Soriano. “The discovery of HIV and new diagnostic methods have been the driving force for new research in viruses in the last 30 years,” he said. “There are now new technologies for diagnosis for viral diseases and advances in antiviral therapy. We know more about hepatitis and influenza because of HIV. In 1996 we saw the introduction of HIV antiviral therapy. This is just happening now for hepatitis C.”
“If you have HIV alone you can be treated with antiretroviral therapy. But if you are coinfected with HIV and hepatitis C then a problem could be cirrhosis of the liver. We now have four different classes of new antivirals for hepatitis C and the clinical trials confirm that more than 2/3 of cases of hepatitis C can be eradicated with this kind of treatment.”
Dr Soriano feels that one reason why there are so many more people infected with hepatitis C today than HIV (45 million HIV positive versus 300 million hepatitis C sufferers) is because HIV communities tend to be well organized. “We don’t really know how hepatitis is transmitted for many individuals so it is difficult to find a strong community,” he said. “The gay population are a strong community and their organization has been quite powerful. They have attracted attention from politicians and administrators. Other diseases, such as hypertension and hepatitis C, do not have such powerful lobbies.”
Universal access to treatment remains a challenge with a variety of barriers to development. “Europe is almost unique in its approach,” Dr Soriano said. “Apart from in California and New York state, in the rest of the world you need to pay for medication, which is a huge obstacle. The situation in western Europe is of great privilege. How long will it last? Our HIV patients can have normal work and families. Their life expectancy is much better than in other countries in the world. Access means money. Drugs are expensive and someone has to provide the money. More than half of the world’s HIV patients live in sub-Saharan Africa. Treatment is increasingly available, but this means that you have only 2-3 options. In Europe or the US you have 25 options. If you fail one drug there are further possibilities.”
However, Dr Soriano remains encouraged by the enormous progress made with European patients in recent years, as a potential model for others to follow, in the event that obstacles can be overcome. “My patients are much more optimistic,” he said. “My clinic now looks very nice. We talk about diet, sport and taking medication. It is nothing like 15 years ago. At that time it was just a matter of surviving. Now it is quality of life. Our clinic no longer sees patients with full-blown AIDS. We are managing cholesterol and good immunity.”
Hear more from Dr Soriano at the May 2012 ISHEID conference. Register now.
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