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Presentations at the 2011 Conference on Retroviruses and Opportunistic Infections reflected the resurging interest in antibody responses against HIV given the encouraging results of the Thai vaccine trial. A plenary talk and an entire symposium were devoted to HIV-specific antibody responses describing newly isolated, potent neutralizing monoclonal antibodies. These antibodies undergo extensive somatic mutation to achieve their remarkable neutralizing properties. Inducing these types of antibodies by vaccination, however, still represents a challenge. New data were presented suggesting that neutralizing antibodies, but not binding antibodies, can provide protection against infection in the nonhuman primate (NHP) model. Several interesting discoveries were also reported showing that cellular immune responses recognizing HLA-C and HLA class II molecules might also be important in control of viral replication. Finally, new vaccine studies in the NHP model showed that electroporated DNA, along with the adjuvant interleukin 12 may be an efficacious vaccine regimen.

The 19th Conference on Retroviruses and Opportunistic Infections (CROI) highlighted new information and provided in-depth discussion on advances in antiretroviral therapy (ART). Data regarding investigational drugs, including integrase strand transfer inhibitors (InSTIs) and zinc-finger nucleases disrupting CC chemokine receptor 5 (CCR5), were presented. Treatment trials in treatment-naive and treatment-experienced patients added to the knowledge base of which antiretroviral agents to initiate and when. Data from trials and observational cohorts suggested that, for patients on successful ART in resource-rich settings, mortality from non-HIV-related diseases may surpass that from HIV-related diseases, and overall lifespan may be nearing that of people without HIV infection. In resource-limited settings (RLS), prevention of mother-to-child transmission (PMTCT) and ART scale-up remained priorities. New data on antiretroviral resistance in RLS and on the implications of low-frequency mutations were presented.

Thirty years after the first AIDS cases were reported in the United States, the HIV epidemic continues to be heavily concentrated among men who have sex with men (MSM) in the United States. MSM are heavily impacted throughout most of the world and are the predominant risk group throughout the Americas and Western Europe; heterosexuals are the predominant risk group in sub-Saharan Africa; and injection drug users predominate throughout Eastern Europe and Southeast Asia. In the United States, blacks and Latinos continue to be disproportionately affected, despite overall advances in HIV testing and care. The 2011 Conference on Retroviruses and Opportunistic Infections focused on populations heavily impacted throughout the world: adolescents, women, MSM, and serodiscordant couples. Several presentations focused on the unique relationship between herpes simplex virus type 2 (HSV-2) and HIV-1; although many opportunistic infections increase HIV acquisition risk, HSV-2 is likely the only one whose effective prevention or treatment could substantially influence HIV infection rates, because of the high prevalence and persistence of HSV-2. The 2011 conference also celebrated the substantial advances made in the use of antiretroviral drugs for prevention of HIV acquisition (eg, oral preexposure prophylaxis, topical microbicides) and transmission (eg, antiretroviral therapy). Further progress is also being made in evaluating other prevention strategies and their rollout, including male condoms, male circumcision, and HIV testing and linkage to care.

Issues relevant to the nervous system garnered substantial attention at the 18th Conference on Retroviruses and Opportunistic Infections. Several topics emerged as areas of importance both for informing current understanding of HIV-related neurologic disorders and their treatment, and for spurring future investigations. Measurable biomarkers of HIV-associated neurocognitive disorder (HAND) were a major theme, with studies ranging from new investigations of known laboratory and imaging markers to identification of novel molecules that might be investigated as potential means to follow disease activity as well as to better understand etiology of disease. Studies of pathogenesis of HAND and simian immunodeficiency virus–mediated neurologic injury added to prior understanding of lentivirus neuropathogenesis. Another broad area of investigation was the interplay between treatment with antiretroviral or adjunctive therapies and biomarkers of HAND. New data were presented on the potential importance of acute and early infection on the integrity of the central nervous system, complemented by studies of the effects of early treatment interventions.

Studies on the efficacy of and drug interactions with the hepatitis C virus (HCV) direct-acting antivirals (DAAs) in HCV/ HIV coinfection were a highlight of the 2012 Conference on Retroviruses and Opportunistic Infections. The addition of an HCV protease inhibitor (PI) to pegylated interferon alfa/ribavirin increased HCV cure rates by 30% to 35% in HCV genotype 1 treatment-naive HIV-coinfected patients, an increase similar to that observed in HIV-uninfected HCV-infected patients. Drug interactions with antiretrovirals can be complex, and DAAs are recommended for use only with antiretroviral drugs for which pharmacokinetic data are available. Further drug interaction and clinical data are needed to ensure the safe coadminstration of DAAs with antiretroviral therapy. The conference placed continued emphasis on pathogenesis, management, and prevention of the long-term complications of HIV disease and its therapies, including cardiovascular disease, lipodystrophy, renal disease, alterations in bone metabolism, and vitamin D deficiency, along with a growing focus on biomarkers to predict development of end-organ disease. HIV has increasingly been recognized as a disease of accelerated aging, manifested by increased progression of vascular disease, cellular markers of aging, and a heightened risk of certain non-AIDS-defining malignancies. This year's conference also highlighted data on diagnosis, prevention, and complications of tuberculosis coinfection as well as the treatment and prevention of coinfections that are common with HIV, including cryptococcal meningitis, influenza, and varicella zoster.