Twenty-five years ago, the first Conference on Retroviruses and Opportunistic Infections (CROI) was held in Washington, D.C. It was a time when researchers were still studying the first generation of antiretroviral drugs and treating AIDS-associated infections. In this exclusive 51˶ video, Robert Schooley, MD, of the University of California San Diego, and Paul Volberding, MD, of the University of California San Francisco, look back on those twenty-five years of AIDS and HIV research.
Following is a transcript of their remarks:
Schooley: CROI started back about 1993 at a time when the International AIDS Meeting was where everyone went to present their data. That year there was a meeting in Florence, and a bunch of the Republican senators, particularly Jesse Helms, felt that it was a waste of government money to be sending government employees to a foreign country to talk about a disease that was not important. So en route, the U.S. government researchers from the CDC and the NIH were called back to the NIH and CDC. They landed in Rome and turned around, and got on the plane and came back, and were not allowed to participate in the meeting.
The NIH asked us if we would put together a meeting in the U.S. that they could go to where government workers, in particular, could present their work rather than not being able to interact with other scientists and push the agenda forward. At the time, I was involved with the AIDS section of the programming for the American Society for Microbiology's annual meeting, and the ASM put on the first conference on retroviruses and opportunistic infections the following year. It really came as a request on the part of the NIH and the CDC to be allowed to have a venue within the domestic U.S. that government workers could present their work and interact with scientists from other institutions.
Volberding: It used to be an annual meeting in Washington, D.C., and after a few years, it then started going to Chicago in the middle of wintertime. But in the last few years, it now alternates between Seattle and Boston, so we get to know the conference center really well.
Schooley: The first CROI was at a time when we were four, five years into the first generation of antiretroviral drugs. We knew that they helped, but we knew that before too long, no matter which drug you started, drug resistance would develop and patients' disease would pick back up again. We were at a time we were still very interested in trying to learn how to treat a lot of the AIDS-associated infections because people were continuing to have cryptococcal meningitis and Pneumocystis even with the antiretroviral drugs.
Volberding: We had the beginnings of some treatments, then, AZT and a couple other drugs, but nothing effective. This conference really, in fact, was the first place where some of the most important developments in treatment were presented in 1996. This conference has really kind of followed the progress of the epidemic.
Schooley: We hadn't gotten to the point, by 1996, when we learned that three drugs put together, particularly a potent drug like a protease inhibitor added to that mix, could turn what was a temporary change for the better to one that was nearly permanent. It took, really, to the third CROI when Emilio Emini presented the Merck 035 study that we entered the era of modern antiretroviral chemotherapy. The first CROI, a lot of us hoped we would get there, but none of us thought we'd get there as quickly as we did three years later.
Volberding: Fittingly now, we're talking about implementation science and vaccine development. We still have some targets, but the treatments now are almost uniformly one pill once a day, no side effects, and essentially always work as long as the person takes them. We've come an immense distance, but there are still people getting infected, and there are still people who, for a variety of reasons, mostly social reasons, aren't really able to continue taking their one pill once a day. The challenges now are often behavioral as well as medical. How do we better understand what it is in people's lives that keeps them from being able to take these amazing drugs? How do we get them back in care and keep them there?