As a follow up to this morning's plenary session, I attended this session which I believe will be of interest to some colleagues back in Australia.
It was great to see Jenny Hoy from the Alfred Hospital moderating this session!!!!
The studies presented were
- Statin Therapy Reduces Coronary Non-calcified Plaque Volume in HV Patients: A Randomised controlled Trial
- Rosuvastatin Arrests Progression of Carotid Intima - Media Thickness in Treated HIV
- Calcified Plaque Burden is Associated with Serum Gut Microbiota -Generated TMA in HIV
- Varenicline vs Placebo for Smoking Cessation
- Body Composition Changes after initiation of Raltegravir or Protease Inhibitors
- Fracture Prediction with Modified FRAX in Older HIV+ and HIV- men
- Exposure to ARVs and development of CKD (Chronic renal disease)
- Renal and Bone Safety of TAF vs TDF
The studies were very well presented and indicate the importance of continued research into the co-morbidities that occur in our HIV positive patients
Just to summarise some of the conclusions from some the studies of interest
1. Statin therapy prevented the progression of coronary athersclerosis and reduced overall plaque volume, especially lipid laden non calcified plaque volume .
Statin therapy reduced high risk morphology plaques
Statin therapy was safe and well-tolerated
Statin effects on arterial inflammation could not be adequately assessed but atorvastatin reduced a systemic marker of vascular inflammation
2. There appears to be a potential association of choline metabolism to subclinical atherosclerosis in HIV, assessed in relationship to plaque burden with the use of a sensitive CG angiographic technique
This relationship may be from altered gut flora or microbial translocation unique to HIV.
There is a need to assess the role of gut micro biome on CVD in HIV
3.The study on varenicline would be of interest to primary care physicians. Varenicline is safe and well-tolerated and effective as an adjunct to counselling in HIV positive patients as in general population and should be considered in HIV case management
Treatment of tobacco dependance in PLWH is a challenging priority.
4. PI/r or INSTI regimen initiation led to similar increases in limb fat with similar increases in central fat but ATV/r containing arm tended to have higher gains in Lean Body Mass (LBM) than DRV/r but LBM gains were similar in pooled PIs vs INSTI
Higher pre-ART inflammatory markers were associated with increases in peripheral fat and LBM but not central fat
5. Studies have shown an association between the use of some ART and renal impairment as we all know. Implications from one of the studies in this oral presentation indicate cumulative increasing risk of Chronic Kidney Disease with increasing exposure to TDF, ATV/r, LPV/r in persons with an initially normal eGFR. The risk is cumulative over time.
A reminder that individual's risk of CKD can be calculated using the D:A:D CKD risk score to help determine benefits/risk in incorporating ARVs into ongoing treatment regimen
6. Looking at Tenofovir Alafenamide (TAF)- the novel prodrug of Tenofovir (TDF) - we await in anticipation in Australia!!!!
2 large RCT with detailed protocol specified renal and bone end points, confirmed favourable safety and tolerability profile of TAF and that compared with TDF. TAF demonstrated no discontinuations due to renal Adverse effete, significantly smaller decreases in eGFR, significantly less proteinura, albuniuria and tubular proteinura, significanly less impact on spine and hip BMD and overall, greater increases in fasting lipids TC HDL same.
Most likely explanation for this = 90% lower tenofovir plasma exposure with TAF vs TDF
I would encourage colleagues to look up the webcasts which will be available later on.