Selected plenary talks at BHIVA 2023
17 May 2023. Related: Early access, Conference reports, Treatment strategies, Side effects, Lipodystrophy and metabolic complications, BHIVA Gateshead 2023.
Simon Collins, HIV i-Base
As always, BHIVA 2023 included a diverse range of plenary talks that covered important aspects of care in the UK.
All talks are now easy to view as webcasts using the links included below.
Navigating new pandemics: what have we learnt
In the opening talk at BHIVA 2023, Susan Hopkins from UKHSA compared responses to three global pandemics – 1918 flu, HIV and COVID-19.
This included the importance of working as part of international and global networks to understand and organise the appropriate responses to reduce transmission and manage treatment. Importantly, these are different for each new health threat. The talk also covered the range of recent issues that UKHSA responded to including H1N1, Ebola, MERS, zika, STI outbreaks (MDR gonorrhoea, LGV, mpox).
Looking to the future, G7 countries have launched a 100-day challenge in which to identify, test and treat any new pathogen. Population-based responses however, such as masking, isolation and lockdown, are political rather than medical decisions.
Ref: Hopkins S. Navigating new pandemics: what have we learnt. BHIVA 2023. Plenary talk.
Overview of the UK cascade
Three talks were included in a symposium on the UK HIV Care Cascade.
Although impressive, a repeated theme included how the actual levels are significantly lower the that 95:95:95 targets suggest. This relates to the methodology used to estimate these goals, especially in the way that people who fall out of care are missing from the data.
I-Base also covered this symposium in detail in a separate report.
Overview of the cascade: where should we focus next? BHIVA 2023. Symposium with three plenary talks.
HTB. UK cascade data cautions UNAIDS 95:95:95 targets: re-engaging people with care.
https://i-base.info/htb/45425 (i-Base detailed report)
Impact of COVID and Ukraine war on HIV care in Europe and central Asia
Sanjay Bhagani from the Royal Free Hospital, London, talked about the impact of COVID, Ukraine and mpox on the HIV care cascade across Europe and central Asia regions.
For all the difficulties, some new health innovations – new models for care such as telemedicine and new way to provide care (including home testing and longer prescriptions). However, not all these developments were universally acceptable or equally accessible by all demographic groups.
The Russian war against Ukraine disrupted services in a country with more than 270,000 people living with HIV, where many were not on effective ART, and that caused a huge displacement of refugees.
The talk covered numerous initiatives for new partnerships across the region to reestablish and then maintain HIV and other care.
Ref: Bhagani S. Of pandemics and wars. BHIVA 2023. Plenary talk.
Public health approach to HIV treatment and the impact of drug resistance
Nick Paton, from the National University of Singapore, presented the evidence for changes in the approach to ART in countries that deliver population-based HIV care.
This included how evidence from several randomised studies including DAWNING, ERNEST and NADIA showed continued antiviral activity of nucleoside analogues, even with evidence of extensive drug resistance to this class.
This supports the importance of retaining tenofovir from first-line ART in second-line combinations without the need to use AZT or resistance testing. The studies also support using dolutegravir and darunavir/r interchangeably as the third component of either first- or second-line ART.
Ref: Paton N. Public health approach to HIV treatment and the impact of drug resistance. BHIVA 2023. Plenary talk.
Management of extensive drug resistance: UK access to latest drugs
Laura Waters from the Mortimer Market Centre, London, talked about the definition, management and treatment of people with extensive drug experience.
This included the importance of access programmes to ensure that people who need these options are able to use them, even if they might not meet strict prescribing criteria in the drug license. The talk included information on fostemsavir, ibalizumab and lenacapavir.
Ref: Waters L. Highly Treatment Experienced: what it means & best management. BHIVA 2023. Plenary talk.
https://vimeo.com/822955414 (webcast, from 30 minutes)
Community programme: myths, misconceptions and other patient questions
This symposium covered a wide range of practical questions asked by members of the UK-CAB and included examples of adherence that still cause problems, even with modern meds that involve much fewer pills. It also covered:
- New drug interactions that might be missed by non-HIV doctors including GPs.
- Limited data for supplements that are not included on the Liverpool drug interaction website.
- Side effects including the relatively recent focus on weight gain.
- Issues related to stigma and disclosure including when travelling to some countries and whether or not doctors letters are still needed.
Ref: Tablet tales – myths, misconceptions and other patient questions. BHIVA 2023. Community symposium.
Providing mental health care and wellbeing in HIV
This symposium included two linked presentations relating to providing mental health care and psychological support as part of HIV care.
In the first, Sarah Rutter from Manchester University NHS Foundation Trust, talked about updating the standards of care with results from a consultation with people living with HIV. Hajra Okhai from University College London also provided an important update in the approach to addiction treatment.
In the second talk, Andrea Hearn from Newcastle Upon Tyne Hospitals NHS Foundation Trust provided an important overview on addiction treatment.
Providing mental health care and wellbeing in HIV: Learnings from the field. BHIVA 2023. Symposium.
Rutter S and Okhai H. Updating the Standards for Psychological Support for Adults Living with HIV: Results of the stakeholder pre-consultation. BHIVA 2023.https://www.bhiva.org/file/645ba46c3cd2f/Sarah-Rutter-Hajra-Okhai.pdf (slides)
Hearn A et al. Recent updates in the provision of addiction treatment. BHIVA 2023.
Weight gain, cardiovascular disease and integrase inhibitors
In an important invited lecture, Andrew Carr from St Vincent’s Hospital, Sydney, provided a detailed review of the data on weight changes and cardiovascular risk with ART and the recent associations to integrase inhibitors.
This included the historical timeline for linking individual HIV drugs to side effects that were not initially reported in phase three studies. It also included understanding the role of other HIV drugs that have recently been associated with weight loss.
This talk will be reported in a separate HTB article.
Ref: Carr A. Longer-term safety of integrase inhibitors. BHIVA 2023. Invited lecture.