Aging with HIV and AIDS: A growing social issue

As the first people with HIV grow old, a new study from St. Michael's Hospital questions whether the health care system and other government policies are prepared to meet their complex medical and social needs.

29 jun 2014--In high-income countries such as Canada, 30 per cent of people living with HIV are 50 or older, and many are living into their 60s and 70s. In San Francisco, more than half the people with HIV are over 50.

"It's a positive thing that people are aging with HIV," said Dr. Sean B. Rourke, a neuropsychologist who heads the Neurobehavioural Research Unit at St. Michael's. "This shows that Ontario is doing its job to help people living with HIV have access to the medical systems and antiretroviral medications to keep HIV at bay. But a very significant crisis is looming."

In a study to be published in the July issue of the journal Current Opinion in HIV and AIDS, Dr. Rourke noted that aging for people with HIV may be more challenging than for the general population because of HIV-related stigma, loss of friends and social networks, and the detrimental health effects of the virus and medications taken to combat the virus.

Older people with HIV are more likely to experience mental health and neurocognitive impairments than other people of the same age, as well as more social isolation. A study in the United States found that 94 per cent of people with HIV who were over 50 have at least one other chronic illness, with an average of three conditions.

Pension plans and health care facilities are not designed for, or expecting, people to have these issues at younger ages, Dr. Rourke said. Geriatric physicians are not trained for working with HIV, and those trained for HIV are not trained in geriatrics.

As a large number of people with HIV approach retirement age, policy makers need to develop new policies or adapt the existing ones to improve their social and economic outlook. He said people aging with HIV who are still working may need more time off to take care of themselves or rest breaks during their shifts; reforming retirement benefit programs could allow people with HIV to remain in the workforce as long as possible; retirement homes and long-term facilities need to be more welcoming places for older people living with HIV.

Individuals with HIV continue to live with health consequences that limit their ability to participate in society. This could mean the inability to work or engage in a community. Some people have to remain jobless or in low-paying jobs so they can receive social assistance and government-funded drugs.

Dr. Rourke said a growing body of research is exploring interventions and other coping strategies to minimize the negative impact of aging with HIV, including being proactive and managing treatment appropriately. Eating properly, exercising regularly and taking care of health needs earlier are much more important with a chronic illness like HIV, he said.

Provided by St. Michael's Hospital

IAC: New Estimate Raises HIV Incidence Sharply

By Michael Smith

MEXICO CITY, 04 aug 2008-- Every 10 minutes, another American becomes infected with HIV.
About a third of them are younger than 30, nearly half are black, and more than half are men who have sex with men.
These startling figures arise from a new CDC analysis of HIV incidence, using a novel method that the agency believes is more accurate than earlier estimates.
In 2006, the CDC now says, about 56,500 people were newly infected in the U.S. The number is sharply higher than the estimate the CDC had been giving for recent years, of about 40,000 a year.
If the estimate is correct, more than 150 people are infected every day, or more than six an hour.
The new analysis "provides the first direct estimates of HIV incidence in the United States using laboratory technologies previously implemented only in clinic-based settings," said Irene Hall, Ph.D., of the CDC, and colleagues.
The study appears in the Aug. 6 issue of the Journal of the American Medical Association and was released here in conjunction with the 17th International AIDS Conference.
The new estimate is not directly comparable to earlier figures, Dr. Hall and colleagues said, and might be higher owing to bias in the new methods, limitations of the older methods, or higher HIV incidence.
But the new method is a "significant breakthrough," said Kevin Fenton, M.D., Ph.D., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
Speaking in a telephone press conference, Dr. Fenton said, "We have never before been able to directly measure new infections in the U.S. on a national level."
Previous estimates have been based on newly reported diagnoses, but were not able to establish when the infections took place. "We have not been able to see the leading edge of the epidemic," Dr. Fenton said.
The new figures were also derived initially from reports of new HIV diagnoses in 22 states, part of an expanded HIV surveillance network. The novel aspect of the analysis is the so-called BED HIV-1 capture enzyme immunoassay, which can distinguish recent from long-standing infections.
In 2006, the 22 states reported 39,400 new HIV diagnoses. Of those, 6,864 had specimens available to be tested using the BED assay and 2,133 ( 31%) were classified as recent infections. Extrapolating to the full U.S. yielded the 56,500 figure, whose 95% confidence interval ranged from 48,200 to 64,500. The estimated incidence rate was 22.8 per 100,000 people (with a 95% confidence interval from 19.5 to 26.1).
A statistical back-calculation yielded a similar number -- an estimated 55,400 new infections per year for 2003 through 2006, the researchers said. Dr. Fenton said new infections were probably never as low as the 40,000 figure and have been roughly stable since the late 1990s.
Analysis of the 2006 figures suggests that 34% of the newly infected were younger than 30, that 45% of them were black, and that 53% were men who have sex with men, Dr. Hall and colleagues reported.
"The bottom line is that the HIV epidemic in the U.S. continues to spread, and at a rate greater than was previously thought," according to Julie Davids, executive director of CHAMP, a New York-based advocacy group.
In a statement, Davids called for "the establishment of a comprehensive and accountable national AIDS strategy that will eliminate barriers to effective prevention, generate adequate resources, and hold our government accountable for ending this epidemic."
The implications of the new findings are unacceptable, said CDC director Julie Gerberding, M.D., and more must be done to lower infection rates. Dr. Gerberding, quoted by the New York Times, said "we are not effectively reaching men who have sex with men and African-Americans to lower their risk."
The CDC has been criticized for not releasing its figures earlier, preferring to wait until they could appear in a peer-reviewed journal.
Primary source: Journal of the American Medical AssociationSource reference:Hall HI, et al "Estimation of HIV Incidence in the United States" JAMA 2008; 300(5): 520-529.

IAC: TB Drug Alters Power of HIV Medication

By Michael Smith
MEXICO CITY, 04 aug 2008-- TB patients treated with rifampin (Rifadin, Rimactane) are more likely to fail subsequent HIV therapy if it includes nevirapine (Viramune), researchers said here.
On the other hand, there is less risk of virological failure if TB patients start HIV treatment with a regimen that includes efavirenz (Sustiva), according to Andrew Boulle, M.B.Ch.B., of the University of Cape Town, in South Africa, and colleagues.
But when HIV patients already taking either drug began TB treatment with rifampin, outcomes were comparable to those in patients without TB, Dr. Boulle said.
The finding comes from a study that appears in the Aug. 6 issue of the Journal of the American Medical Association and was released here in conjunction with the 17th International AIDS Conference.
The issue is important in resource-poor countries, where non-nucleoside reverse transcriptase inhibitors such as nevirapine and efavirenz are recommended as components of an initial antiretroviral drug regimen.
Rifampin is a potent inducer of cytochrome P450 enzymes, which metabolize many drugs, including the non-nucleoside reverse transcriptase inhibitors.
Indeed, plasma concentrations of both nevirapine and efavirenz are reduced by the drug, although nevirapine is hardest hit with reductions of between 20% and 55%.
To see what the effects of such reductions might be, the researchers studied HIV treatment-naïve patients in a public sector antiretroviral therapy program in three centers in South Africa.
The analysis included 2,035 individuals who started antiretroviral therapy with efavirenz (including 1,074 who already had TB) and 1,935 who started with nevirapine (including 209 with concurrent TB).
Compared with patients without TB, those with TB (and on rifampin) who started nevirapine were twice as likely to have an elevated viral load six months later. The rate was 16.3%, compared with 8.3%, a difference that was significant at P<0.05.
They were also quicker to develop virological failure -- defined as two consecutive test values of more than 5,000 copies of viral RNA per milliliter of blood. The adjusted hazard ratio was 2.2, with a 95% confidence interval from 1.3 to 3.7, which was significant at P<0.05.
There were no differences between patients starting efavirenz with or without concurrent TB.
And there was no difference in time to virological rebound in patients free of TB compared with those who developed tuberculosis during follow-up while taking either nevirapine or efavirenz.
The latter finding, however, should be taken with a grain of salt, Dr. Boulle said, because the number of patients who developed TB during HIV treatment was relatively small.
Indeed, one of the main limitations of the study as a whole, he said, is that only 209 patients started nevirapine with concurrent TB, which limits the power of the analysis.
Another limitation of the study is that neither survival nor CD4 counts were affected by the antiretroviral regimen in the patients with TB. The assumption made was that virological failure would result in clinical failure.
The study was also observational so the investigators could not exclude confounding by indication for choosing nevirapine as opposed to efavirenz as the initial regimen.
There was no external support for the study.
Dr. Boulle reported no conflicts.
Primary source: Journal of the American Medical AssociationSource reference:Boulle A et al "Outcomes of Nevirapine- and Efavirenz-Based Antiretroviral Therapy When Coadministered With Rifampicin-Based Antitubercular Therapy" JAMA. 2008; 300(5): 530-539

IAC: HIV Care Guidelines Expand Treatment Eligibility

By Michael Smith
MEXICO CITY, 04 aug 2008 - About 100,000 additional HIV-positive patients in the U.S. would be eligible for initiation of antiretroviral therapy under new treatment guidelines issued here.
The 2008 recommendations of the International AIDS Society-USA Panel support initiating therapy even in patients whose immune system remains relatively robust, according to Scott Hammer, M.D., of Columbia.
The guidelines remove the previous upper limit of 500 CD4-positive T cell per microliter of plasma, above which therapy was not recommended, Dr. Hammer said.
He said the changes "substantially increase the eligible group" of HIV-positive people in the U.S., although he was unable to give more than a "ballpark" figure of about 100,000.
The guidelines appear in the Aug. 6 issue of the Journal of the American Medical Association and were released in conjunction with the 17th International AIDS Conference.
The guidelines are intended to guide HIV care in the developed world, Dr. Hammer said, but in the long run, the 14-member panel that developed them hopes they will also guide care in developing countries.
Previously, antiretroviral therapy was recommended if a patient's CD4 cell count fell below 200 cells per microliter of plasma and was recommended for consideration when the count was between 200 and 350.
Therapy was not recommended for patients whose CD4 cell count remained above 350.
In the new guidelines, therapy should begin at 350, and in any case before the count reaches 200, Dr. Hammer said.
Above 350, therapy should be considered on an individual basis, based on co-morbidities, risk factors for progression to AIDS and other diseases, and patient readiness for treatment, he said.
For 2008, the panel also removed the upper limit of 500 cells, suggesting that - depending on the other factors - treatment could begin at any CD4 level, Dr. Hammer said.
The changes came as a result of several factors, he said, including more antiretroviral drugs, a better understanding of the adverse effects of delaying treatment, and more insight into the role of HIV in non-AIDS conditions such as cardiovascular and renal disease.
Currently, Dr. Hammer said, there are 25 individual drugs in seven classes, approved for HIV therapy in the U.S. and - in what he called a sign of "maturation" for the field -- two others have gone out of production.
The range of available drugs has alleviated fears that early therapy would leave patients without options if and when resistance or toxicity developed, he said.
And mounting evidence suggests that a high viral load - regardless of CD4 cell count - is linked to increased morbidity and mortality, he said.
Also, trials of treatment interruptions have suggested that HIV has a role in cardiovascular disease, non-AIDS malignancies, renal disease, and liver disease, he said.
All those factors "support moving forward to earlier initiation of treatment," he said.
The guidelines continue to recommend that initial treatment be based either on a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI), combined with two nucleoside or nucleotide reverse transcriptase inhibitors (nRTI).
The preferred NNRTI is efavirenz (Sustiva), but several PIs are suggested, including lopinavir (Kaletra), atazanavir (Reyataz), fosamprenavir (Lexiva), darunavir (Prezista), and saquinavir (Fortovase, Invirase).
The suggested nRTI combinations are tenofovir/emtricitabine (Viread/Emtriva) and abacavir/lamivudine (Ziagen/3TC).
If abacavir is being considered, the guidelines suggested that patient monitoring should include testing for the immune marker HLA-B*5701, which is associated with abacavir hypersensitivity reactions.
The guidelines also suggest that, before the CCR5 antagonist maraviroc (Selzentry) is used, patients be tested for so-called viral tropism, the type of virus causing their infection.
For all patients, including those experienced with HIV medications, Dr. Hammer said, the goal remains to drive the viral load below the level of 50 copies of viral RNA per milliliter of blood, which is the lower limit of detection for the most sensitive assays.
Primary source: Journal of the American Medical AssociationSource reference:Hammer SM et al. "Antiretroviral Treatment of Adult HIV Infection: 2008 Recommendations of the International AIDS Society-USA Panel." JAMA. 2008;300(5):555-570

IAC: Injection Drug Use No Bar to HIV Therapy

By Michael Smith
MEXICO CITY, 04 aug 2008-- Injection drug use doesn't change the chance of survival among HIV-positive patients starting highly active antiretroviral therapy (HAART), researchers said here. In a 10-year observational study, injection drug users had death rates that were similar to other HIV-positive patients starting HAART, according to Julio Montaner, M.D., of the University of British Columbia in Vancouver, and colleagues. The finding should quash the common view that people who use injection drugs are inherently unable to benefit from therapy because of their unstable life style, said Dr. Montaner, who is also president-elect of the International AIDS Society.
The study appears in the Aug. 6 issue of the Journal of the American Medical Association and was released here in conjunction with the 17th International AIDS Conference.
The study implies that extending HAART to injection drug users "should be a priority, given that barriers remain" to access, Dr. Montaner said, adding that the Joint United Nations Program on HIV/AIDS has found that -outside of sub-Saharan Africa - a third of all HIV infections are among injection drug users.
The study covered all antiretroviral-naïve residents of the Canadian province of British Columbia who started HAART between Aug. 1, 1996, and June 30, 2006.
The 3,116 patients, with a median age of 39.4, included 915 injection drug users and 579 females. The median duration of follow-up was 5.3 years for the drug users and 4.3 years for others.
Dr. Montaner said previous studies showing worse outcomes for injection drug users on HAART were performed in areas where access to treatment was not free.
He noted that HIV/AIDS care is free in British Columbia, removing a major barrier to care.
A province-wide vital statistics bureau allowed all patients to be followed until death or the end of the study and their causes of death analyzed.
The study found that 622 study participants died during the study period, for a crude mortality rate of 20.0%. Of those, 232 were injection drug users.
The cumulative all-cause mortality rate was similar between the groups -- 26.5% for the drug users and 21.6% for the others - and in a multivariate time-updated Cox regression, the hazard ratio of mortality was also similar (1.09 with a 95% confidence interval from 0.92 to 1.29).
In sub-analyses, Dr. Montaner and colleagues excluded deaths unlikely to be related to HIV, including such things as accidental poisonings, trauma, and suicides.
The drugs users were significantly more likely (P=0.003) than non-users to die of such causes - they accounted for 21.1% of such deaths compared with 9.7%.
However, when accidental deaths were excluded, the death rates again were not statistically different -- 22.4% for the drug users compared 19.1% for the others.
The bottom line, Dr. Montaner said, is that "once barriers are removed, injection drug users can successfully enter treatment."
The study was limited by only having baseline data on injection drug use. So any effect of ongoing drug use could not be ascertained.
The study also only enrolled injection drug users who had HAART prescribed. The authors acknowledged that the overall rate of death might be higher if all injection drug users were counted. Nonetheless, the study demonstrated that injection drug users given HAART had a similar mortality rate to those who did not inject drugs.
The study was supported by the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research. Dr. Montaner receiving educational grants from and serving as an ad hoc advisor to or speaking at various events sponsored by Abbott Laboratories, Agouron Pharmaceuticals Inc., Boehringer Ingelheim Pharmaceuticals Inc., Borean Pharma AS, Bristol-Myers Squibb, DuPont Pharma, Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Immune Response Corp., Incyte, Janssen-Ortho Inc., Kucera Pharmaceutical Company, Merck Frosst Laboratories, Pfizer Canada Inc., Sanofi Pasteur, Shire Biochem Inc., Tibotec Pharmaceuticals Ltd., and Trimeris Inc.
Primary source: Journal of the American Medical AssociationSource reference:Wood E at al. "Highly Active Antiretroviral Therapy and Survival in HIV-Infected Injection Drug Users." JAMA. 2008;300(5):550-554.

IAC: Effects of Growth Hormone Raise Caution Flag

By Michael Smith
MEXICO CITY, 04 aug 2008 -- Low doses of growth hormone reduce abdominal fat deposits in patients with HIV lipodystrophy, researchers said here. In an 18-month, placebo-controlled randomized trial, the hormone also improved blood pressure and triglyceride levels, according to Steven Grinspoon, M.D., of Massachusetts General Hospital and colleagues. On the other hand, the hormone appeared to increase some aspects of blood sugar levels, injecting "a note of caution" into the debate over using growth hormone to treat lipodystrophy, Dr. Grinspoon and colleagues said.
The study appears in the Aug. 6 issue of the Journal of the American Medical Association and was released in conjunction with the 17th International AIDS Conference.
The study is "very informative to the field," Dr. Grinspoon said, noting that off-label use of growth hormone is common.
"Even low-dose growth hormone, albeit effective in reducing cardiovascular risk factors and better tolerated than high-dose growth hormone, may increase specific glucose parameters," Dr. Grinspoon said.
The researchers enrolled 56 patients with HIV, abdominal fat accumulation, and reduced secretion of growth hormone, defined as a peak of less than 7.5 ng/mL of blood.
They were randomized to placebo or growth hormone, starting at 2 mcg/kg of body weight per day, and titrated up to a maximum of 6 mcg/kg over the 18 months of the study.
The study found that the treatment effect - the average difference between the two groups - was:
A reduction by 19 cm2 in visceral adipose tissue, which was significant at P=0.049.
A reduction of 0.8 kg in trunk fat, which was significant at P=0.04.
A drop of 7 mm Hg in diastolic blood pressure, significant at P=0.006.
A 7 mg/dL reduction in triglycerides, significant at P=0.002).
An increase in levels of insulin-like growth factor-1, a marker for growth hormone, by a treatment effect of 129 ng/mL, which was significant at P<0.001.
An increase in two-hour glucose levels (on glucose tolerance testing) of 22 mg/dL, significant at P=0.009.
Adverse events were not significantly different between the groups.
Dr. Grinspoon said that most glucose parameters were unchanged by the growth hormone, but increases on the two-hour test may be an early marker of diabetes.
He said the study showed that those whose two-hour glucose test was worsened by growth hormone were those who had poor glucose tolerance at baseline.
Because of that, he said, "I don't think growth hormone can be recommended for all people with HIV, but it might be quite useful for a subpopulation."
The study was supported by the NIH. EMD Serono provided growth hormone but made no other contribution to the study. Dr. Grinspoon reports research support on an unrelated project from EMD Serono and also serving as a consultant for the company. He also reported financial links with Theratechnologies.
Primary source: Journal of the American Medical AssociationSource reference:Lo J et al. "Low-Dose Physiological Growth Hormone in Patients With HIV and Abdominal Fat Accumulation: A Randomized Controlled Trial." JAMA. 2008;300(5):509-519.

HIV Screening Can Be Cost-Effective at an Advanced Age

By Michael Smith
DURHAM, N.C., 17 june 2008-- As more and more older Americans remain sexually active, HIV screening should be considered for some until age 74, researchers here said.Screening in older adults can make economic sense if the HIV prevalence in the population to be tested is 0.1% or greater, according to Gillian Sanders, Ph.D., of Duke University's clinical research institute and colleagues. It's even more cost-effective if less-expensive "streamlined" screening is used and if the patient has a sexual partner at risk for HIV, Dr. Sanders and colleagues said in the June 17 issue of the Annals of Internal Medicine.
Current CDC guidelines call for routine screening of Americans ages 13 through 64, Dr. Sanders said, but a mathematical model -- based on available prevalence data and other factors -- suggests that cutoff may be too early.
"Even if a person is over 65, the risk factors (for HIV) should still be looked at," Dr. Sanders said. "Prevalence is higher than people think -- and it doesn't have to be that high for screening to make sense."
Although HIV is often thought of as a disease of young adults, she noted that "19% of those infected were diagnosed at 50 or older."
The computer model that Dr. Sanders and colleagues used tracked older patients over their lifetime, noting whether they were screened, their HIV status, the clinical course of HIV, the effects of HIV transmission, and the cost and effects of treatment.
In the model, they included patients ages 55 through 74. Estimates of sexual activity, HIV prevalence, the cost of screening and testing, and other factors were taken from published literature, the researchers said.
Under various assumptions, screening at any of the tested ages could be cost-effective, they found, in terms of the standard measure, quality-adjusted life-years (QALYs).
For instance, if the prevalence of unidentified HIV is 0.5%, and a patient has an uninfected partner at risk for infection, a conventional one-time screening program led to incremental cost-effectiveness of $30,020 per QALY for a 65-year-old patient.
For a similar patient of 75, the incremental cost-effectiveness was $41,520 per QALY, the researchers found.
If the prevalence of HIV is lower -- at 0.1% -- the incremental cost-effectiveness worsens, at $91,410 per QALY for the 65-year-old and more than $100,000 per QALY for patients 70 or older.
The cost-effectiveness is also worse if the patient does not have a sexual partner at risk for HIV, the researchers said.
On the other hand, streamlined screening -- in which pre-testing counseling is minimal and post-test counseling is extensive only in the case of a positive result -- improved the cost-effectiveness for all ages.
The model's results depend on how much HIV there is in a population and how sexually active patients are, Dr. Sanders and colleagues said -- data that are not easy to come by.
But in earlier research among 8,627 veterans they found the prevalence of undocumented HIV infection to be 0.7% in outpatients 55 through 64, 0.5% in those 65 through 74, and 0.1% in those 75 or older.
And a recent study of 3,005 U.S. adults found that 73% of people 57 through 64, 53% of those 65 through 74, and 26% of those 75 to 85 were sexually active.
On the basis of these data and the results of their analysis, the researchers recommended one-time voluntary HIV screening with streamlined counseling on a routine basis for everyone 55 through 64 years old.
They also urged one-time screening, targeted to sexually active people ages 65 through 74, if the HIV prevalence is greater than 0.1%.
Dr. Sanders said physicians should remain aware of the possibility of HIV infection, especially if any of the conventional risk factors are present, regardless of age.
"All of us also need to remember that age doesn't protect anyone from HIV," she said. "You're as vulnerable at 60 as you are at 16."
The study was supported by the Department of Veterans Affairs, the National Institute on Drug Abuse, the National Institute on Aging, the Ontario Ministry of Health and Long-Term Care, and the Ontario HIV Treatment Network. The authors reported no conflicts of interest.

Primary source: Annals of Internal MedicineSource reference:Sanders GD, et al "Cost-effectiveness of HIV screening in patients older than 55 years of age" Ann Intern Med 2008; 148: 889-903.

Experts call for more access to HIV care

By MERAIAH FOLEY, Associated Press WriterSun Jul 22, 5:34 AM ET
The world will not be able to celebrate advances in HIV diagnosis and treatment until the United Nations' goal of universal access to drugs is reached, leading international AIDS researchers said at a conference Sunday.
"We are dealing with a preventable disease and 11,000 people are contracting HIV/AIDS every day. We are dealing with a treatable disease and more than 3 million people are dying every year," said Pedro Cahn, the president of the International AIDS Society.
"Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice ... is a shameful failure on the part of the global community."
More than 5,000 delegates from 133 countries have converged on Sydney, Australia, for the Fourth International AIDS Society Conference on HIV Pathogenesis and Treatment, which runs through Wednesday.
Researchers from across the globe will present their findings on the benefits of circumcision for cutting HIV rates through to the latest developments in anti-retroviral drugs.
Lower prices for HIV drugs have significantly improved access to treatment for people in poor countries, but recent World Health Organization figures show the numbers are still far short of the U.N.'s goal of universal coverage by 2010.
Last year, some 2 million people in developing countries were receiving the anti-retroviral drugs that help treat the HIV infection, a 54 percent increase over 2005. But overall, only 28 percent of the world's HIV patients are receiving the life-prolonging drugs.
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said the world health community could not celebrate the great breakthroughs in the treatment HIV/AIDS since it was first diagnosed 26 years ago until greater steps are made to prevent the disease.
"Of the projected 60 million infections that will occur by 2015, fully half of them are projected to be able to be prevented with already known and proven prevention methods," Fauci told reporters in Sydney.
"Before we celebrate 26 years since the beginning of extraordinary accomplishments, we're actually going to be judged as a society in what we do in the next 20-26 years," he said. "We cannot sustain a successful effort with HIV without prevention."
Participants at the AIDS conference will be urged to sign a declaration aimed at raising more money for HIV research.
The so-called Sydney Declaration calls on national governments and bilateral, multilateral and private donors to allocate at least 10 percent of all HIV/AIDS-related funding to research.
"We believe that without such funding we will fail to maintain a sustained and effective response to the AIDS pandemic," the declaration says.
The conference organizers say this will help speed up the implementation of new drugs and technologies to prevent, diagnose and treat the infection.