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AIDS Conference Marks 25 Years Since Disease Was Identified

Thousands of HIV/AIDS researchers and advocates are descending on Toronto, Canada for the 16th International AIDS conference, which opens Sunday. The theme of the conference, "Time to Deliver," reflects both the frustrations and the hope of the international AIDS community.

The first cases of HIV were reported in the United States 25 years ago in June.

Anthony Fauci remembers it well. Fauci, who heads the U.S. government's Institute of Allergy and Infectious Diseases, has become the most visible face of AIDS research in the United States.

But back then, Dr. Fauci was an infectious diseases specialist, flipping through a copy of a government surveillance newsletter, when he saw a report on five healthy homosexual men in Los Angeles who had contracted pneumonia.

A second report soon followed of 45 men in a number of large U.S. cities who had contracted not only pneumonia, but a rare form of cancer.

"I knew we were in some serious trouble. I did not, in my wildest dreams, imagine how serious a problem this would be," he said.

For a long time, HIV was thought to be confined to middle-income, white homosexual males in North American cities.

But as sociologists began to learn more about the disease and looked beyond U.S. shores, Fauci says they found HIV/AIDS was widespread.

"It already was a global issue, but only because of the health care delivery system in the United States and western world was it recognized here first," he noted. "So, if we fast-forward 25 years, what we have now is more than 65 million cases of HIV, 25 million of which have died. There are now 38.3 million people living with HIV."

And, according to the World Health Organization, there are an estimated 3 million AIDS deaths each year and 4 million new infections.

Over the past two decades, treatment with anti-viral drugs and prevention strategies, through education and safe sex practices, have made HIV a manageable disease, but there's still no cure.

An AIDS vaccine remains an elusive goal because the AIDS virus does not behave like other pathogens. According to Fauci, there has never been a documented case of an HIV-infected person suddenly becoming well.

Scientists have tried for years to understand why the body cannot get rid of it the way it eventually fights off other viruses such as smallpox, measles and polio. But over the past two-and-a-half decades, researchers have increased their understanding of HIV, and there will be no shortage of technical presentations in Toronto.

It is well known how HIV disables the immune system by commandeering T-cells, which are involved in the activation and regulation of the immune system.

But researchers at the University of Montreal have been studying the role of another immune system cell called a macrophage.

Eric Cohen of the department of human retroviral research says he and his colleagues are trying to find out why a so-called "reservoir" of HIV remains in the body in spite of aggressive treatment with anti-viral drugs designed boost the immune system.

The researchers think it is because HIV burrows into macrophages to avoid detection.

"What I'm going to be talking about at the AIDS conference is really some of the study that we have done to try to understand the intracellular pathways that are used by the virus to either reach the plasma membrane in some cell types or those intracellular compartments where they hide and avoid the immune response," said Mr. Cohen.

The Toronto AIDS conference will provide an international platform for what has become a serious, but unrecognized health crisis, the co-infection of HIV/AIDS and tuberculosis.

According to experts, up to 75 percent of people infected with HIV in some countries are also sick with life-threatening TB.

"Governments and the international community must recognize that they've got on their hands two simultaneous and interrelated catastrophes," said Stephen Lewis, the United Nations Special Envoy for AIDS in Africa. "And that is true worldwide, wherever the two interact. So, we must confront both together. We need more resources, we need more diagnostics, we need better drugs, and we need the HIV and TB components working together."

In the end, the Toronto conference is not expected to be the stage for any earth shattering announcements. Instead, Anthony Fauci expects it will be a consolidation of the latest research into trying to understand the AIDS pandemic.

"Although we talk a lot about the research accomplishments, the prevention and the care and the treatment of people are really the bottom line issues, including access in developing countries," he added.

Researchers say access to anti-AIDS drugs, while not a cure, can transform a deadly disease into a manageable one.