ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
DAY 2; parallel session -Non Infectious and Metabolic Co-morbidities
Laura Benjamin (Wellcome Trust Liverpool Glasgow Centre for Global Health Research) presented her research on a cohort of HIV patients suffering stroke in Malawi. She found an increased risk associated with lower CD4 count but not with viral load. The strokes were mainly ischaemic rather than haemorrhagic. There is increasing evidence of stroke as a co-morbidity and it is thought to be due to HIV- related vasculopathy causing inflammation and endothelial dysfunction. It is important to consider treatment failure with opportunistic infection if stroke occurs in someone on ART.
Neurocognitive impairment remains an important problem in HIV patients despite ART. Carmela Pinnetti (Italian Ministry of Health) presented a study exploring the association between neuronal injury markers and NCI. She confirmed that plasma and CSF markers were important indicators of impending NCI. Valentina De Zan (Department of Microbiology, Verona University) then pointed out that despite ART, the HIV virus may persist in CSF and can escape causing neurological symptoms. She studied 46 neuro-symptomatic. She found CSF viral detection at a higher rate than plasma as well as undiscovered viral resistance. Optimisation of ART led to 65% recovery although a few relapsed at a later date.
Aoife Cotter (Consultant in Infectious Diseases at the Mater Misericordiae and St Vincent’s University Hospitals)presented the POPPY study. This looked at an aging group of HIV patients, over and under 50yrs against controls over 50yrs. The older patients had lower BMD after correcting for other variables. A higher CD4 count and current ART were associated with lower BMD. Tara McGinty (Clinical Research Fellow, UCD School of Medicine, Dublin) confirmed HIV as an independent predictor of reduced BMD but stressed the need to assess trabecular bone score as well, (this is also reduced in HIV.) The lumbar spine is more effected and predictably smoking, and prior fracture were the most important predictors of more severe osteoporosis
Pablo Ryan (Hospital Universitario infant Leonor, Madrid) pointed out that osteonecrosis is more common in people living with HIV (PLWH.) They require THR. He compared complication rates in HIV vs controls in 348,000 patients who underwent THR in Spain including 1018 HIV+ve. ON rates were higher in HIV but there were no differences in surgical complication rates.