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.
Glasgow Day 3: HIV and comorbidities
One of the focuses of Day 3 of the HIV Drug Therapy Glasgow Congress was co-morbidities and HIV management, and how this affects patient care.
Dr Edouard Battegay from the University Hospital in Zurich presented in the morning on multimorbidity in HIV infected people as they age. He stated that multimorbidity (the presence of multiple concurrent medical conditions) often occurs in clusters, and the complexity of managing the conditions, including potential drug-drug interactions, increases exponentially with each additional condition. Common clusters in HIV–infected people include hypertension and dyslipidaemia, and pain and depression.
The EACS guidelines for 2016 are one of the first sets of guidelines to systematically address comorbidities in DDIs in a specific disease. Dr Battegay’s presentation prompted discussion of the relative and overlapping roles of HIV specialists, primary care physicians and specialists in managing these multiple conditions as the focus often shifts from the HIV infection, which is often stable, to management of the individual’s comorbidities.
Expanding on this exploration of the needs of the ageing HIV-positive population, Dr Charles Cazanave from France spoke about the results from a cross-sectional analysis of the ANRS CO3 Aquitane cohort. He described the evolution of chronic non-HIV related disease and their risk factors in 2,138 patients included in this cohort between 2004 and 2014. The mean age of the cohort increased from 42 to 52 years and the majority (71%) were male.
He found that there was a significant improvement in HIV markers over the ten-year period, but also an increase in renal and cardiovascular risk scores, with rates of dyslipidaemia increasing by 40%, and rates of hypertension increasing by 37%. There was also a high rate of smoking in this cohort (40%), reinforcing the importance of addressing lifestyle factors in comprehensive HIV management. One of the limitations of this analysis was that there wasn’t a HIV-negative control group for comparison to see what happens to the rates of these conditions in the general population over a similar ten year period.
Is HIV-related lipodystrophy associated with an increase in the risk of morbidity and mortality? Dr Estaban Martinez’s 20 year longitudinal cohort study asked this question and found that, contrary to their initial hypothesis, lipodystrophy or lipoatrophy (but not lipohypertrophy alone) was associated with a reduced risk of death in the group studied. This was thought to be due to the fact that in the cohort studied, the presence of lipodystrophy is a proxy for effective viral suppression with antiretroviral medication. LA, LD and LH were, however, all associated with an increased risk of hypertension and diabetes.
Finally. Dr Davide de Francesco reported on results from the POPPY study in UK and Ireland, which showed that the HIV-positive people studied exhibit poorer cognitive scores when compared to controls, and there is a correlation with increased scores on depression-rating scales. He concluded that reduced cognitive function may be mediated by depression or the two conditions may in fact be related to the same, as-yet unelucidated, pathophysiological process.