This is some original artwork which themed all of the sessions at IAS this year. As is the custom in Australia, we acknowledge the Jagera people and the Turrbal people as the Traditional Custodians of Meanjin (Brisbane), the land on which IAS 2023 is taking place. We pay our respects to Jagera and Turrbal elders past, present, and emerging.
Michael and Dr C summarized today together, once again. As a community member-physician team,
we have learned a lot from each other. One hears things the other does not. One knows what the
other does not. We used a lot of acronyms today. In the positive lounge, folks talked about HIV
having a wealth of acronyms.
Today, we learned about approaches to cure, including dealing with reservoirs, bnAbs, T
cell vaccines. There were studies of risk of weight gain or diabetes with INSTI’s, Doxy-PEP
again, meningitis vaccine partly effective against gonorrhea (again), lifestyle changes can
decrease risk of heart disease in PWH, Calcium and Vitamin D supplementation during puberty
can improve bone density in children, and increased risk of death in PWH when providers stop
long term opiates in patients with positive urine screens for stimulants. We heard more about
including women in studies, especially cardiac, given cis female with HIV have double the risk
of heart disease compared to cis men with HIV.
We spent time in the “Positive Lounge” and met an Australian chap who is developing an online resources for patients to know about current Australian HIV specific guidelines with ASHM (Australian Society of HIV Medicine
https://ashm.org.au/), especially for patients in rural areas with no HIV specialists. We want to
build a similar resources with Pozabilities and SDHIVC. His plan is to streamline the tool so
that the patient only needs to enter a few criteria, like age, gender and year HIV diagnosed.
Researchers are studying patients who have natural or post treatment control of HIV, i.e.,
suppressed HIV RNA after ARV interruption. Some viral periods are short, weeks, but still,
something to learn. After bnAbs, suppression has occurred for 6 months or more. It surprised us
that 1/3 of patients with natural HIV control reported no satisfactory sex life. We wonder how
the general population reports on sexual life. What percentage of people don't enjoy sex? There
are lots of different shades of this term, but the basic definition is a lack of interest in sex or less
of an interest in sex than others. About one percent of the population identifies this way
according to Asexual Visibility and Education Network
Challenges with HIV reservoirs include qualifying differences between cells that are
replication viable or not in varying reservoirs, especially those that are harder to find and unclear
if infectious. There is variability in patients who can control the virus without medicines. Some
have been controlled for years and then breakthrough and must restart ARVs. In these patients
with no detectable HIV not on medicines, there is increased physical health, fewer symptoms,
more social and intimate relationships, but more health concerns and mental disorders versus
other people with HIV.
Integrase strand inhibitors (INSTI) related changes in BMI and risk of diabetes
There was more on weight gain and diabetes with INSTI’s. One large study of 30,000 PWH
showed little to no difference in diabetes for INSTI compared to non INSTI users. What was
significant is if one started with a high BMI, there is more weight gain after starting ARV’s
despite class of ARVs. The following graph shows incidence of diabetes in INSTI users versus non-
INSTI users. If a patient has a low BMI, there is little chance of new diabetes after INSTI is started. By the
time the X axis line gets to a BMI of 30 or more, the two lines separate, and you see that there is
significant incidence after starting INSTI. This parallels studies showing the risk of weight gain.
In RESPOND, current use of INSTIs vs. non-INSTI was associated with an increased risk of
diabetes which partially attenuated when adjusted for BMI changes and other variables. There
was no difference in DM risk between current TAF and TDF users. In adjusted analyses current
TAF use had similar DM risk to current TDF. There was little evidence of an interaction
between log BMI, INSTI and non-INSTI use.
Vitamin D and calcium intake are associated with bone deficits among adolescents living
with HIV in Zambia and Zimbabwe
Supplemental Vit D and Calcium during puberty led to increased bone density. The study
was in Zambia and Zimbabwe, where we were told that 10% of children with HIV have
osteoporosis compared to 6% in HIV negative children. There were 842 participants, most were
female. 75% had low calcium consumption and 25% had low vit d consumption.
Effects of lifestyle modification and annual screening in the prevention of cardiovascular
risk factors in South African women with HIV
Women with HIV (WHIV) are faced with an added burden of obesity and hypertension,
particularly in under-resourced settings. We sought to assess the effectiveness of regular
screening and lifestyle modification interventions in modifying CVD risk factors in South-
African WHIV. Unfortunately, they did not report what lifestyle or annual assessments were
done. There was no effect on obesity, but there were significant improvements in fasting glucose
and also in cholesterol (HDL increased and LDL decreased). They noted that women are at
higher risk of metabolic syndrome and have double cardiovascular risk compared to men).
Four major themes emerged from the data, namely perceived body image, benefits barriers and
recommendations to improve adherence to WHO-PEN lifestyle modification management. They
also assessed if they believed that HIV associated stigma hindered access to care. They found
that financial limitations and the lack of social support posed barriers to adherence to programme
participation. They were further challenged by poor body image perception. Participants believed
that such interventions offered them hope and feelings of improved well-being. Women
recommended that lifestyle modification interventions such as those studied in the ISCHeMiA
study should include partners and family to improve adherence through social support.
Effects of lifestyle modification and annual screening in the prevention of cardiovascular
risk factors in South African women with HIV
The authors assessed the effectiveness of regular screening and lifestyle modification
interventions in modifying CVD risk factors in South-African WHIV.
Re-evaluating risk: evaluating opioid-related harm associated with stimulant use in people
with chronic pain living with and without HIV Sherika HANLEY, South Africa
This study included 300 PWH and 300 HIV negative.2012 to 2019 in San Francisco.
They assessed whether a stimulant positive urine toxicology screen results were associated with
increased: 1) opioid-related emergency department (ED) visits (oversedation, constipation,
infections associated with injecting opioids, and opioid seeking); and 2) Long term opiate
discontinuation 90 days following a stimulant-positive UDT. There was no association with ED
visit or death within 90 days of a positive urine screen for stimulants in PWH or HIV negative
subjects. However, stimulant use was associated with subsequent discontinuation of long-term
opiates within 90 days. Discontinuation of opiates was more likely among Latinx individuals
and less likely among PWH . The speaker suggested that detection of stimulant use should result
in a discussion of substance use and risk, rather than reflex to discontinue opiates.
Discontinuation of opioids can cause a great deal of harm, even death. As background, the
speaker told us that 1 in 5 PWH were prescribed opioids for chronic pain in 2011. One in 10
used stimulants. Stimulant and opioid use increased during covid, as did deaths. There is a well-
known increased risk of overdose if opioids suddenly suspended.
We also want to note an important study reported yesterday that circumcision in MSM
reduces risk of HIV. Michael will give a summary of the presentations on neurocognition in
HIV, which was the best session we attended, and a topic very important to the current HIV
community.
Finally, the Closing Ceremony did not offer new information. There was discussion
about the goal to end HPV cancers, including cervical, anal and oral, by using screening and
gender-neutral vaccination, i.e., vaccinate everyone—transgender, cis female and cis male. Dr
Anthony Fauci and others talked about how HIV and COVID research cross pollinate each other.
He also highlighted the importance of social determinants of health.
