XVIII International AIDS Conference

The Double-Edged Sword: Long-Term Complications of ART and HIV MOSY03

Type:
Symposium Back
Location: SR 1
Schedule: 14:30 - 16:00, 19.07.2010
Code: MOSY03
Chairs: Joel Gallant, United States
Jose Arribas, Spain
Webcast provided by The Kaiser Family Foundation

The success of highly active antiretroviral therapy, HAART, has been evident for 15 years. Such long-term therapy can have complications though, especially when compounded by co-morbid conditions such as ageing and smoking. In recent years studies have shown that avoiding or switching from thymidine analogues can prevent or reduce complications, though such drugs are still commonly prescribed globally. More recent problems such as cardiovascular risk, bone and renal disease are now becoming a focus for treatment decisions. With a movement to start treatment earlier at higher CD4 counts, the lifelong risks of complications are yet to be determined. Allowing HIV to go untreated, even at relatively high CD4 counts, is also not without problems. HIV is thought to induce a state of long-term inflammation, which may lead to cardiovascular events, renal and hepatic complications and tumors. This panel will explore the problem of complications of HAART and the need to treat early.



Presentations in this session:

14:30
MOSY0301
Slides with audio
Introduction



14:33
MOSY0302
Slides with audio
Bones of contention: HIV and bone disease
Presented by Paddy Mallon, Ireland



14:48
MOSY0303
Slides with audio
HAART to heart: HIV and cardiovascular disease
Presented by Georg Behrens, Germany



15:03
MOSY0304
Slides with audio
Kidney conundrums: HIV and renal disease
Presented by Mohamed Atta, United States



15:18
MOSY0305
Slides with audio
Out of sight out of mind: brain impairment/dementia and HIV
Presented by Victor Valcour, United States



15:33
MOSY0306
Slides with audio
Questions and Answers



15:58
MOSY0307
Slides with audio
Conclusions







Rapporteur report

Track B report by Jose ARRIBAS


The first symposium of the meeting under the clinical sciences track-The Double-Edged Sword: Long-Term Complications of ART and HIV-was held on Monday, 19.07.2010 with four presentations.

In the first presentation, on the “Overview of bone disease and HIV”, Dr. Mallon made very key observations:

-          Low bone mineral density (BMD) is more prevalent in HIV infected patients and seems to be progressive.

-          It is still nuclear in the incidence of bone fractures is increased in HIV infected patients.

-          More research is needed to determine if Z or T scores are better to estimate the risk of future fractures in HIV infected patients.

-          Both HIV itself and antiretrovirals contribute to a decrease in BMD

-          High prevalence of Vitamin D deficiency among HIV infected, associated with EFV exposure in some studies

-          All HIV infected patients should be screened for their risk of bone fracture. DEXA scans only for patients with high risks.

Dr Behrens then reviewed “HIV and cardiovascular disease” in the second presentation, during which he highlighted the following:

-          The increasing incidence of cardiovascular events among HIV-infected

-          The important role of traditional risk factors which are also highly prevalent in HIV-infected

-          HIV therapy and HIV by itself both contribute to the increase CV risk but added that data on abacavir conflicting at present.

-          Other potential important factors could be microbial translocation and persistent inflammation despite suppressed HIV replication.

-          All patients should be evaluated and suggested EACS guidelines as a good guide.

In the third presentation,-“Kidney conundrums-; HIV and renal disease”. Dr Atta reviewed the implications of renal disease in the course of HIV infection and the possible impact of early HAART in kidney disease in HIV infected patients. The following were notable observations in this presentation:

-          Microalbuminuria is a very important marker of cardiovascular risk.

-          Decreases in glomerular filtration rates area also associated with an increased CV risk.

-          HAART is highly efficacious to treat HIVAN. Recent data suggest that among the black population, genetic markers determine the risk of developing HIVAN.

-          HAART can impact renal function through an increased risk of diabetes, HTN, crystalluria (indinavir, atazanavir) or other direct nephrotoxic effects (tenofovir). Finally our aging population would maker renal disease more prevalent.

-          Apart of the benefits on HIV, there’s no clear data suggesting a general benefit on renal function or early HAART.

In the final presentation -“Out of sight out of mind -Brain impairment/dementia and HIV”.-Dr Valcour reviewed the issue of cognitive impairment in HIV infected. There is an asymptomatic epidemic of neuro-cognitive impairment despite the use of HAART. This is probably occurring because HAART is not sufficient to clear HIV from the CNS reservoirs as well as the effect of other co-morbidities (psychiatric disease, hepatitis C, aging etc). Much more research is needed to understand the pathogenesis of this complication and possible treatments.

 

 

 

 

 

 

 




   

    The organizers reserve the right to amend the programme.


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