Politics trumps science at International AIDS Conference

Bangkok, Thailand's Impact conference center swarmed with 19,843 delegates to the annual global meeting on AIDS this week, but Hall 3, where the scientific posters were displayed, was eerily quiet. Some experts say that's because science took a back seat to politics at the 15th International AIDS Conference, which closed on Friday with no major research breakthroughs reported and a vaccine, the holy grail in the war on the incurable virus, still years away. Aside from incremental progress on antiretroviral drugs, which may offer new ways to keep the HIV virus at bay with fewer adverse side effects, the scientific agenda of the conference was notable more for challenges faced than progress made. "Generally, I don't expect a lot out of these conferences, but there seems to have been nothing really new at this one," said John Shriver, head of vaccine research at U.S. drug company Merck. An HIV vaccine is the best hope of ending the pandemic that has killed 20 million people, infected almost twice that number, and hits another 14,000 people a day. But a majority of the 30 vaccines in clinical trials are still at an early stage and all are focused on a similar approach, which may not work. The world's biggest vaccine trial began in Thailand last September and aims to recruit 16,000 volunteers, although fewer than 4,000 have so far received the shots. Hopes for the project, however, are not high, because it involves combining Aventis's Alvac vaccine with VaxGen's AIDSVAX, which has already failed in two previous large-scale trials. Thai and U.S. researchers believe the two shots together may work better than AIDSVAX alone, but many experts are skeptical. A group of 22 scientists criticized the trial in the journal Science earlier this year, arguing the $119 million the U.S.-funded project will cost is a waste of money. In the absence of an effective vaccine, a protective gel or cream may be the best hope. Zeda Rosenberg of the nonprofit International Partnership for Microbicides said a product could be on the market within five years. But the concept still has to be proved. Researchers believe a microbicide could be easier to develop than a vaccine and estimate that even a partially effective cream, gel, foaming tablet, or vaginal ring could prevent 2.5 million deaths from AIDS over three years. Helene Gayle of the Bill and Melinda Gates Foundation, who as incoming president of the International AIDS Society will cochair the next AIDS summit in Toronto in 2006, acknowledged the science had been lackluster in Bangkok. "This is not a conference where we have had some of the breaking news and advances in science we have had at some of the previous conferences, but I think that is to be expected," she said. "As this epidemic continues to mature, we will find more incremental progress." The emphasis of the conference has shifted markedly since 1985, when AIDS scientists first met in Atlanta, and issues of policy and protests by activists have grabbed more and more of the limelight. "As we broaden this conference and broaden the base of participation, we keep struggling with how to make sure this conference stays balanced," Gayle said. (Reuters)