Notes from the National Conference for People Living with HIV

[Jim Allen]

Orignal thread: https://forums.poz.com/index.php?topic=77577.0

Speakers:
Professor Fiona Lyons

Prof. Fiona Lyons is a consultant in Genitourinary Medicine at the GUIDE clinic, St. James’s Hospital, Clinical Professor in Genitourinary Medicine at the School of Medicine, Trinity College, Dublin, and the national Clinical Lead at the HSE Sexual Health and Crisis Pregnancy Programme.

Dr Jane O’Halloran

Dr Jane O’Halloran, University College Dublin, graduated in Medicine from National University of Ireland, Galway. She completed Specialist Registrar training in Infectious Diseases and Internal Medicine and did her PhD thesis with Dr Patrick Mallon at University College Dublin on the mechanisms contributing to increased disease in HIV infection.

My notes
Welcome:

• Sandy Preston (Positive Now) and Erin Nugent (HIV Ireland)

HIV Ireland NGO, Erin Nugent - upcoming projects:

• Focus group with the Irish Dental Association to reduce the stigma experienced by people seeking dental care.
• Public speaking training for women.
• Focus/support group for older gay men session who have experienced loss due to HIV & AIDS.

HIV Update Prof. Fiona Lyons (HIV in 2024)

• HIV Treatment & Cure: Treatment has come a long way in a short time. Pre-HAART - Hit early and hard -  The wait era - Treat all era. This fast development speed is impressive compared to other conditions, thanks to activists, particularly in the early years. However, don't expect a cure within working lifetime.
• Life expectancy. In the era of "treat all" and "U=U" etc., life expectancy is "normal". However, studies into this don't predict an individual's life expectancy—many individual factors.
• Injectable ART. (CABENUVA): Particularly older adults, women, POC are under-represented. Some evidence indicates treatment failure & developing resistance seems more common in HIV-1 subtypes A6 & A1 and also under those with a high BMI. More study is needed.
• Viral load blips.Continuous blips over 200 are important indicators. However, low-level blips are mostly insignificant.
• Antibiotic treatment & low CD4 Counts. Not everyone's CD4 count will recover, and if the person has a stable and suppressed viral load, we are now discontinuing Seprin/Bactrim antibiotic treatment. (Example was two years post ART without CD4 recovery)
• 95-95-95 targets. On-target and HIV Meds have greatly improved over the years; people have access to treatment without cost in Ireland, allowing people to live "normal" lives; however, what about the 5%? We can't just leave 5% of the community behind.
• Are you worried about your health? Then stop smoking!

HIV and Ageing Dr Jane O'Halloran

• Statins for all PLHIVs over 40. This broad statement doesn't mean what most think, and there is no one-fits-all solution. Instead, an individual, holistic approach and considerations need to be made, with Statins being a potential option.
• Multi-morbidities: With ART working so well, PLHIV as a group have been ageing, and with that comes the challenge of managing more co-morbidities and multi-morbidities. We need increased focus on reducing smoking, exercising more, better diets, lowering BMI, etc.
• Weight gain. So, 1980s HIV wasting, mid-1990s Lipodystrophy. Thanks to HAART and continued development to improve ART, these aren't the challenges today, but obesity is from the mid-2000s. What are the factors, and is it the medication?

• We live in a far more obesogenic environment today. Obesity is a health challenge in the population regardless of HIV status.
• Of those starting HIV treatment within the past ten years, 50% were overweight when starting and had more significant weight gain.
• Return to health, untreated HIV uses a lot of energy, and once suppressed, this energy usage drops to "normal"
• Could modern medications be a factor? Perhaps, but that's only part of the story, and contradictory results exist.
• Some older medications might have impaired cells in a particular way or protected against a certain level of weight gain.

• Frailty Strong evidence between cumulative anticholinergic medication use and recurrent falls and, to a lesser extent, frailty.  Such as Codeine , citalopram, loperamide, amitriptyline and diazepam.
• Hepatic steatosis in PLHIV.  The prevalence of hepatic steatosis and fibrosis was similar between older participants regardless of HIV status. Drink less alcohol and reduce BMI.
• Modern times: The "treat all" "U=U" everything is a "normal" era, and messages/campaigns today do not reflect everyone in the HIV community. The vast lived experience and reality for many PLHIV today are different to this as it also depends on when someone was diagnosed and at what stage. We need to remember this when discussing HIV.
• Stop smoking! Exercising more, better diets, lower BMI, connect with community.

Some references & related topics we have previously covered on the forums.

HIV Ireland NGO
www.hivireland.ie

Reporting VL below 200 - “harmful medical practice”
https://forums.poz.com/index.php?topic=77575.0

Injectable ART
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923183/

Injectable ART: New HIV drugs with a higher resistance risk should be classed as inferior.
https://forums.poz.com/index.php?topic=77560.0

Ageing - polypharmacy & frailty
https://forums.poz.com/index.php?topic=77483.msg

Evidence for an association between anticholinergic drugs & falls
https://forums.poz.com/index.php?topic=76093.msg

Namsal: Dolutegravir-Based or Low-Dose Efavirenz
https://www.nejm.org/doi/full/10.1056/NEJMoa1904340

Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV
https://www.nejm.org/doi/full/10.1056/NEJMoa1902824

TAF vs TDF
https://www.poz.com/article/study-sheds-light-weight-gain-switching-new-tenofovir

Hepatic steatosis in people older and younger than fifty who are living with HIV and HIV-negative controls
https://pubmed.ncbi.nlm.nih.gov/37670375/

Experts recommend statins for all people with HIV aged 40+
https://forums.poz.com/index.php?topic=77510.0

[Jim Allen]

It took me longer to type up my notes than to attend the conference.  Tomorrow, I'll post my notes from the workshops I attended.

[numbersguy82]

Thank you for this Jim! What an interesting read… I have two takeaways… 1) how can we help with weight loss when many frontline drugs cause weight gain and 2) Jim stop vaping!

[Jim Allen]

It was an interesting conference. Although the topics were mostly things we had discussed before on the forums and in the community, it was good to have the presentation and the opportunity & time to ask questions and clarify things.

A lot of conferences are for the professional audience, and it's great to have one for people living with HIV.

1) how can we help with weight loss when many frontline drugs cause weight gain

https://www.youtube.com/watch?v=V20-HfxT0lI

[numbersguy82]

I was very scared to click that link … I had pre-typed “I hate you” but thankfully didn’t need it 🤣

[Jim Allen]

I was very scared to click that link … I had pre-typed “I hate you” but thankfully didn’t need it 🤣

🤣 lol.

Ill post the workshop notes tonight. It had some good pointers about ghosting and online dating.

[numbersguy82]

🤣 lol.

Ill post the workshop notes tonight. It had some good pointers about ghosting and online dating.

Date?!?! Why would anyone subject themselves to online dating 🤣 #notatalljaded