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.