HIV & Hepatitis Nordic Conference 2019

HIV & Hepatitis Nordic Conference 2019 HIV & Hepatitis Nordic Conference 2019 The HIV & Hepatitis Nordic Conference have twice as high risk for cardiovascular ties. Effective treatment of modifiable was held in Stockholm in September 25 disease compared with the background risk factors – such as smoking, high cho- - 27. Almost 300 participants had come population. A study we did on peripheral lesterol and high blood pressure – can to the Swedish capital to attend. artery disease showed that PLWH have a significantly reduce an individual's risk 75 % increased risk for this disease, Prof for cardiovascular disease. Dam Poulsen continued. – The median age of PLWH has increa- – 300 is an ideal number – because it Pulmonary disease in PLWH have a sed. It is estimated that in 2030, 40 % of allows for discussions, and enables new high prevalence of airflow limitation PLWH will be 60 years old or more. This networks to be formed, Prof Magnus of 10 - 15 %, and this is associated with underlines the importance of prevention. Gisslén stated when he greeted them all death. A comparison of 598 PLWH and We should always try to get our patients welcome to the Opening session. 2,598 controls on renal impairment show to quit smoking, she said. It was for the sixth time this annual a prevalence of 3.7 % for PLWH versus Efforts to avoid late presentation may Meeting took place, focusing on the 1.7 %. also decrease co-morbidities. Collabo- Nordic region. The lecturers consisted – The overall prevalence of renal im- ration with GPs is needed in managing of – as always – an exciting mix between pairment in PLWH is 6.4 %, with some the ageing and co-morbid population of international and Scandinavian key-note geographical variation. In Northern Eu- PLWH. speakers. Prof Gisslén, Sweden, was the rope the prevalence is 4 %, Africa has the – I'm not sure GP's are updated on Chair of the Scientific and program com- highest prevalence. The decline in renal drug-drug-interactions (DDIs) and gui- mittee, who also had representatives from function in PLWH on ART is steeper delines – so we have to help them with Denmark, Finland, Iceland and Norway. than that in uninfected. that, Prof Dam Poulsen ended her lecture. Factors contributing to co-morbidi- One of the questions she was asked after Factors contributing to co-morbidities ties are traditional risk factors, ART and The first speaker in Stockholm was Prof HIV-related risk factors. Susanne Dam Poulsen from Copenhagen, – Traditionally, PLWH smoke more Denmark, who gave a lecture on co-mor- than controls and also have a higher bidities in treated HIV infection. use of recreational drugs. That has to be – Distribution of co-morbidities varies taken into account, Prof Dam Poulsen in different patients of the world, Prof underlined. Dam Poulsen said. Co-morbidities are more prevalent in Collaboration with GPs is needed people with HIV, and they occur earlier. Altered body composition and weight – A meta-analysis of 16 studies showed gain are found in PLWH and may contri- that people living with HIV (PLWH) bute to inflammation and co-morbidi- Susanne Dam Poulsen HIV & VIROLOGY NEWS 4· 2019 21 HIV & Hepatitis Nordic Conference 2019 her talk was who should take care of co-morbidities – GPs or specialists in in- fectious diseases? – That is something we need to discuss in our societies. But we do need to help those GP's who do it – with DDIs and guidelines. CSF neopterin not normalized in ART Neopterin is a marker for immune system activation. Dr Frida Rydberg, Sweden, explained that ART treatment during chronic HIV infection does not normalise cerebrospinal fluid (CSF) neopterin. She presented a study that aimed to ex- plore to what extent does ART treatment normalize CSF immune activation mar- kers in patients with chronic HIV and high CD4 cell counts. – 176 patients were retrospectively selected from the longitudinal Gothen- burg CSF cohort study. They had lumbar punctuations at baseline (before ART), 1 year on ART and more than 3 years of creased over time – particularly in female dom comparisons from the background ART. migrants. Employment was associated population. The conclusion was that CSF neopterin with suppressive ART, high CD4 counts – Our first conclusion is that PLWH does not normalize in many patients ini- and self-reported satisfaction with have a nearly 50 % higher prevalence of tiating ART during chronic HIV. psychological and physiological health. comorbid diseases at diagnosis. We saw – This also applies to ART initiation at We also found that people with intrave- an increased incidence of ischemic heart high CD4 cell counts, Dr Rydberg said. nous drug use are an important target disease – including myocardial infarc- group for policies promoting employ- tion – chronic obstructive pulmonary Employment of PLWH increased ment, Dr Carlander summarised. disease, liver disease, moderate to severe over time renal disease and lymphoma, Dr Jespersen PLWH are less likely to be employed than Increased burden of told the audience. HIV-negative people. Rises of unemploy- non-communicable disease Congestive heart disease, cerebrovas- ment is associated with increased HIV The burden of co-morbidities in PLWH cular disease, diabetes I + II and osteo- mortality, said Dr Christina Carlander, in Denmark was the title of a study pre- porosis were not more frequent among Sweden. sented by Dr Niels Jespersen, Denmark. PLWH, but more received treatment for She presented a study with the aim to The study population was all HIV infected osteoporosis. Alcoholism-related and assess employment status in the Swedish residents, who were at least 18 years old mental disorders were more frequent HIV cohort compared to the HIV nega- at time of diagnosis, in the Central Den- among PLWH at diagnosis and during tive population, controlled for migrant mark Region during 1985 - 2017. Each follow-up. status. It was a registry-based study. HIV patient was matched by age, sex and – PLWH have an increased burden of – We found employment of PLWH in- municipality of residence with ten ran- non-communicable diseases, was his last conclusion. CD8 T-cell exhaustion in HIV-2 In HIV type 2, natural control is more common and there is a longer asympto- matic chronic stage compared to type 1. – T-cell exhaustion can be seen in cancer and chronic infections. Its most important hallmark is loss of functional cha- racteristics, such as cytokine production, cytotoxicity, proliferative capacity and skewing of transcriptional factors, said Research assistant Lydia Scharf, Sweden. She presented a study on CD8 T-cell exhaustion, activation and differentia- tion in HIV-2 infection dependent on cli- nical status. A cohort in patients in Guinea- Bissau had their T-cells analysed. Frida Rydberg, Lydia Scharf, Niels Jespersen and Christina Carlander. – In our study we saw a vicious circle 22 HIV & VIROLOGY NEWS 4· 2019 HIV & Hepatitis Nordic Conference 2019 of HIV immunopathology – with T-cell activation leading to T-cell exhaustion which in turn led to disease progression and CD4 T-cell depletion, was Research assistant Sharf's conclusion. New technologies for drug delivery British HIV Association (BHIVA) and HIV Nordic had a joint session entitled Evolving treatment and care. First speaker in this was Prof Chloe Orkin, UK, who talked about new drugs and treatment strategies. She began with an overview of drugs that are available now. – We have a lot of tolerable drugs – and are also starting with 2-drug regimens, Prof Orkin said. Then she presented the new drug pipeline, and underlined that there are also new classes of drugs. All in all there will be 9 classes. vir and rilpivirine. Non-inferiority was Do we need 3 drugs for 50 years of achieved for primary and secondary treatment? According to her, this is ques- endpoints, Prof Orkin continued. tionable. – But at present, no 2-drug regimens Advantages and disadvantages with are recommended as first line of treat- implants ment in guidelines. There are both advantages and disad- Technologies for drug delivery of ART vantages with implants. are becoming more and more important. Advantages include they are removable They include long-acting injection, mi- at end of treatment and for adverse Chloe Orkin croneedle drug patch, oral nanomedi- effects. They have a potential to provide cine and subdermal implants to name a therapy for years with a single insertion few. – and since they are palpable under skin, ARV products for HIV treatment in infants, – This is where the field is going. this indicates receipt of drug. children, adolescents, pregnant and breast- Long-acting drugs are efficacious – pa- – The disadvantages include there is a feeding women. tients stay on them – and are often pre- minor sterile medical procedure requi- – So we need more research, Prof Orkin ferred in other specialities. red for insertion and removal. Palpation stated. The ATLAS study investigated if will not determine duration of use and HIV1-infected adults with current supp- there is a complicated regulatory en- HPV vaccines are safe for PLWH ression on a regimen with 2 nucleoside vironment, Prof Orkin said. Dr Christina Carlander talked about cer- reverse transcriptase inhibitors (NRTIs) She ended her lecture by pointing vical cancer and dysplasia in HIV. plus a third agent, remain suppressed out an article in the Lancet, published – 85 % of all cases are found in low and upon switching to a two-drug intramus- in July 2019. It was on knowledge gaps middle income countries, she pointed cular long-acting regimen of cabotegra- and research priorities on long-acting out. There is a global variation in cervical human papilloma virus (HPV) incidence. There are different genotypes of HPV – genotype 6 and 11 are benign (but account for 90 % of genital warts), and genotype 16 and 18 are high-risk and account for approximately 70 % of all cervical cancers.

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