July 27th, 2014

Really Rapid Review — AIDS 2014, Melbourne

AIDS2014_bannerFor the second time — the first time was in Sydney, 2007 — the annual “summer” international AIDS conference took place in Australia, this time in Melbourne way down in the southern part of the country. I’ll note again how the crash of Malaysia Airlines flight MH-17 cast a sad note over the opening sessions, and throughout the conference many people gave moving tributes to friend and colleague Joep Lange.

This being the larger of the two international meetings, there was plenty of non-medical, non-scientific content, all of which I’ll completely pass over in this Really Rapid Review©.

(Except to say that Bill Clinton and security entourage walked right past me — he waved hello, though clearly not to me personally.)

With the usual up-front apologies for inadvertently omitting something important, off we go.

A few brief impressions of Melbourne, top of the World’s Most Livable City rankings by The Economist since 2011.

  1. The people were uniformly nice, polite, energetic, and helpful. All of them! There must be some ornery and disagreeable Melbourne natives someplace, but they are either extremely small in number or they are carefully hidden away, far from where tourists roam.
  2. As a tennis-crazy person, even though I knew it was illogical, I kind of expected Melbourne to be hot — think of the Australian Open in January, matches held in blistering 40 degree celsius heat with blinding sun, players taken into the locker room for IV hydration, etc. Of course this city’s location in the way south of Australia means it’s not “summer” here at all (see the first line up there), it’s just flat-out winter — cool, cloudy, kind of like Seattle in October/November — but nothing (and I mean nothing) like a Boston winter. Wear a sweater and/or a light coat and you’re fine.
  3. The city has the largest street tram service in the world, and somehow it all works: the streetcars don’t seem to interfere with the traffic or pedestrians, and the stops have incredibly clear and helpful signs telling you not only how long you need to wait for the next car, but the next 3 cars after that. Imagine that on the Boston T on Commonwealth Avenue!
  4. Food is outstanding, with strong Asian influences everywhere, and many of the restaurants are charmingly located on narrow alleyways, with indoor/outdoor dining overlapping to make the alleys seem like outdoor rooms. Tipping is barely required — kind of viewed as sort of a strange American custom. I asked about tipping in one restaurant, as I didn’t have the right currency for both the bill and a tip, and the waitress said (in all sincerity), “That’s very kind of you, but we’re just fine, thank you.”
  5. This is a city of true coffee fanatics, proven by the fact that there are only two Starbucks in all of Melbourne — but don’t go to them! From humble little snack bars to high-end bean emporia, the quality of the coffee here is off the charts sensational. Maybe that’s why everyone is so nice? Helpful for jet lag adjustment too.
  6. Given all of the above wonderfulness, perhaps it’s no surprise that Melbourne is no bargain. (#6 most expensive city in the world, according to this list.) Not eager to see my next credit card statement, yikes.

Next year’s meeting is in Vancouver, which no doubt will celebrate the incredible 1996 Vancouver meeting that introduced effective HIV therapy to the world. Or, to quote Kevin DeCock:

The International AIDS Conference in Vancouver is synonymous with the introduction of highly active antiretroviral therapy (HAART), now just referred to as ART.  

He said it, not me!

6 Responses to “Really Rapid Review — AIDS 2014, Melbourne”

  1. Agustin Muñoz-Sanz says:

    One more time, thanks, Dr. Sax. Your RRR is already an essential ítem in the modern HIV history. Eppur, a classic! In my opinión, in the very next future it will be a SRR (Sustained Rapid Review).
    Greetings from Spain.

  2. Carla Johnson says:

    Thanks for this excellent summary, Dr. Sax. I was one of the few folks from CDC approved for the conference, so I’ve been trying to share some useful summaries with all my colleagues who could not attend.

  3. Maria Castillo says:

    Excellent Rapid Review! Congratulations!

  4. John Everyman says:

    Thank you for this rapid review, Dr. Sax. They are always, always appreciated.

    I have to admit, I’m having a hard time understanding the SECOND-LINE paradox. Is the assumption that a patient with poor adherence to the first regimen will carry this behavior over to the second regimen? Additionally, if the patients with the worst adherence have the least resistance, then who has the most resistance?

    • Paul Sax says:

      . Is the assumption that a patient with poor adherence to the first regimen will carry this behavior over to the second regimen? Additionally, if the patients with the worst adherence have the least resistance, then who has the most resistance?

      John, yes to the first question. As for the second question, we learned in the 1990s that the patients with the worst resistance tend to be those who do not achieve virologic suppression despite excellent adherence, then are maintained on the failing regimen for a prolonged period. This was more common with the toxic and less potent regimens we used back then.


  5. AJ says:

    Excellent overview. Many thanks. So helpful for HIV physicians trying to keep up.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

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