The 19^th edition of CROI is being held at the Washington State Convention Center in the heart of downtown Seattle. This is an imposing structure that renders the 4000+ crowd of scientists, clinical investigators, health researchers and community representatives pretty insignificant. I have been trying to find out what Seattle is famous for, and should have the answer in my next mail. For the meantime, it suffices to say that Jimi Hendrix was born here.

Today’s plenary commenced with a talk from Wafaa El-Sadr on ART for Prevention. Whilst the preliminary results from HPTN 052 confirmed the long-held view that ART had a dual benefit in preventing HIV progression in the host and infection, a number of issues still need to be tackled. For instance, are the results from 052 relevant to other populations beyond the stable HIV-discordant couples studied? What would be the impact of expansion of ART for prevention in discordant couples on the trajectory of the epidemic? What are the resource implications for scale-up of ART for prevention efforts and how does ART for prevention fit within the broader HIV prevention strategy? After the hubbub over the results has died down, the real challenge of translating the successes into reality begin.

Session 7 was on critical treatment issues in women and children. Two back-to-back presentations were on the relationship between use of hormonal contraception and progression in HIV-1. The recently-issues WHO guidelines on the subject has given little reassurance to women living with HIV on the safety of using hormonal contraception, hence the two presentations were of critical importance. Sandra McCoy and her group worked on a study that evaluated the risk of HIV acquisition among women using oral contraceptive pills and injectable hormonal contraception in South Africa and Zimbabwe. Data was analyzed from 4913 sexually active women aged 18 to 49 years participating in the MIRA study (Methods for Improving Reproductive Health in Africa). The study concluded that injectable use was associated with a slightly increased risk of HIV infection compared with non-hormonal contraception, and recommended the use of dual protection with condoms. Renee Heffron, on the other hand, presented data from a prospective study involving 2236 HIV+ women in east and southern Africa, and the conclusion was that hormonal contraception did not accelerate and was instead associated with a reduced risk of HIV-1 disease progression.

Studies that looked at loss to follow-up (LTFU) among HIV+ women show a high level of LTFU by pregnant women than non-pregnant women (19% vs 11% in 5 South African cohorts).

Interestingly, study in Tororo, Uganda, among children concluded that an ART regimen containing ritonavir-boosted lopinavir significantly reduced the risk of malaria than those receiving an NNRTI-based regimen b y 41%. This finding could be used to advocate for the use of PIs as first line for children and other populations in malaria-endemic settings.

The conference continues today with an opening plenary session by Dorothy Mbori-Ngacha on elimination of MTCT (mother-to-child transmission) of HIV.