Interview of Doctor Stefano VELLA

This is a global epidemic. We must solve it at its roots and they are worldwide. AIDS practitioner speaks out on the search for a cure.

On the eve of the International AIDS Society’s 2011 conference in Rome, we spoke to the event’s local co-chair, Stefano Vella, about the most pressing issues facing doctors treating AIDS and infectious disease patients around the world. Dr Vella is also a regular contributor to ISHEID and we look forward to hearing more from him in Marseille next May.

View the updated programme here

Now that effective therapies exist to block HIV replication in infected patients, medical priorities are evolving. For Dr Vella, one of his top challenges is to improve early diagnosis in patients.

“Unfortunately, the majority of our patients come to the clinic very late,” he explained. “Late presenters generally have a lot of other problems, as the disease is often quite advanced. Some of these patients have not just HIV but also accelerated aging problems complicating the picture. We see patients with HIV who are 50-years-old but biologically they are 60-years-old. Also, in southern Europe we see a lot of co-infections, like HIV and hepatitis, which require additional, sometimes complex treatments.”

He said that improving early diagnosis would require a two-fold approach. In the first instance, the onus is on governments to make testing available and easy for everyone. “But we also need to increase awareness of the virus,” Dr Vella added. “We no longer talk of AIDS much in the media and yet there are thousands of new infections every year in Europe. There is an impression that HIV AIDS is over, that it is not a problem anymore because it can be treated. This is not true. Unless we can find a cure, treatment is very complex and is for the rest of the patient’s life. People have a false sense of security and this is why they seem to get infected. Many in Europe think that HIV AIDS is a problem in African and southern countries, not applicable to them.”

Once a patient is diagnosed, there begins the tightrope walk of treatment, with contrasting challenges.

On one hand, access to treatment is not yet universal, certainly between developed and emergent nations but also across Europe. “It is not the same if you are treated in Paris or in the south of Spain,” he said. “Access to good treatment is not equal.”

However, cases of long-term toxicity are also of great concern in patients subject to extended treatment programmes. “Because a cure is not on the horizon, we need to understand if there are strategies to cope with the long-term management of patients”, according to Dr Vella. “If they do not take the drugs regularly they may become resistant and there are certainly long-term consequences of chronic treatment. We are now looking at changing regiments, taking out the most toxic drugs and simplifying the life of the patients. Once started, it is not a good idea to stop treatment entirely but we may simplify.”

Like many practitioners, Dr Vella is committed to the goal of worldwide access to treatment, however he is not optimistic in the short-term, as the global economy struggles to recover following the financial crisis and government donations to the Global Fund to Fight AIDS, TB and Malaria dwindle.“This is a global epidemic,” he said. “Nobody can solve it in their own region without a broader geographic perspective. We must solve it at its roots, and they are worldwide. Universal access could extinguish the epidemic by stopping transmission. We need resources. It is not just a problem of sending drugs. We have problems with health systems and a scarcity of health care workers, too.”

“We should also recognize that the work we are doing with HIV can be transferred to other diseases like TB. AIDS equals global health. We need to make a little jump that is inclusive of the general health of the population, not just HIV. Our treatment models for HIV can be applied to other diseases to contribute to an overall improvement of the health of the poor. The fight against inequalities is a global fight.”

As he counts down the days in final preparation for the IAS event in Rome, where 9000 participants are expected, Dr Vella also reflected on what keeps him coming back to ISHEID each edition.

“I love this conference,” he said. “I appreciate the fact that it is smaller and at the same time very focused on certain specific issues. The chair, Dr Lafeuillade, is able to change the focus each edition. For practitioners, this is good for us. It is an opportunity for us to discuss medicine in detail, more so than at the big conferences, which deal with other, broader issues. After ISHEID I come back with a lot of info but also with a lot of profound thoughts from the very strong discussion forum.”