15th Annual Conference of the British HIV Association (BHIVA), 1-3 April 2009, Liverpool

8 June 2009. Related: Conference reports, Conference index, BHIVA 15th Liverpool 2009.

HTB reports from the conference

• Superinfection identified in 2 out of 8 patients with unexpected viral load increases

• Peripheral DEXA scans to identify rates of reduced bone mineral density

• Vitamin D deficiency, supplementation and tenofovir

• High rate of lost and untested TB biopsy samples and low screening for latent TB

The annual BHIVA conferences consistently provide an opportunity to understand important aspects of HIV care, including the first presentations of results from national audits, lectures from international experts on emerging concerns and a wealth of studies from junior researchers.

The spring meetings are attended by up to 700 delegates from all health care fields including strong community attendance supported by a scholarship programme.

This year’s highlights are detailed in summary reports below. The low-points unfortunately included several company satellite sessions, trumped by a session from GSK suggesting that a patient with a previous history of heart attack – clearly the highest risk for a subsequent heart attack – should continue abacavir because some studies, generally those not designed to look at cardiovascular risk do not support the findings from D:A:D. However, D:A:D is the largest international prospective study powered to look at the cardiovascular impact of antiretroviral therapy.

This session, incidentally, was prior to the most recent statement from the EMEA recognising the complexity of data, (for details and comment see below in this issue of HTB). It is difficult to understand why any doctor would want to be faced with the ethical dilemma of explaining to any patient with a high CVD profile who was maintained on abacavir, when alternative treatment options were available, and who has a subsequent hear attack, or to their family should it prove fatal, why a clear caution from both the D:A:D and SMART studies, had not filtered down to that individual patient.

We rarely report from satellite meetings – even when the content is balanced and informative – and several of the sessions at BHIVA this year were of a very high standard– simply because they are usually skewed by some degree of marketing bias.

However, this year we will make one exception, because the GSK satellite included a case study of a patient with a history of previous heart attack who was recommended to continue taking abacavir. It is difficult to see why, when alternative options are available, abacavir would not be considered as a modifiable risks, at least until the D:A:D results can be explained by other factors.

BHIVA recommends all patients have their cardiovascular risk measured on an annual basis, and certainly prior to starting treatment. Given that many patients report never having been told their cardiovascular risk, this might be a very appropriate area for educational events.

GSK could also have included the information that a prior cardiovascular event is the highest predictive risk factor for a subsequent event, and that patient history in addition to Framingham risk assessment (which doesn’t factor in previous CVD) is critical.

On a more positive note, the abstract book and a selection of slide sets of the oral presentations are available to download from the BHIVA website.

http://www.bhiva.org