Event review: CROI 2016
Stichting HIV Monitoring (SHM) was represented through a number of national and international collaborations, including the following posters involving SHM researchers Ard van Sighem and Daniela Bezemer:
- Ard van Sighem presented a poster on the age dynamics of new HIV infections among Dutch men having sex with men (MSM), on behalf of Oliver Ratmann (see interview earlier in this newsletter). The data showed that the increasing age at diagnosis among MSM is likely a consequence of complex, changing transmission dynamics by age. In particular, young men are increasingly linked within the epidemic and infect relatively more older men than previously.
- Daniela Bezemer presented a poster on the introduction of non-B HIV subtypes in the Netherlands through the MSM population. Her research showed that non-B subtypes have gone on to form national sub-epidemics with different outbreak sizes.
- Furthermore, Joost Vanhommerig and Daniela Bezemer presented a poster investigating the overlap of the HIV and hepatitis C epidemics among MSM in the Netherlands using a phylogenetic approach. They found that HCV infection was not confined to specific HIV clusters, indicating that there are no specific HIV clusters with an elevated risk of HCV infection. When multiple HCV infections were present within an HIV cluster, concordance of HCV phylogeny was relatively uncommon, even among those with concordant HCV genotype. According to the authors, one explanation may be that HCV spreads in MSM networks that differ from the HIV transmission networks.
SHM was also represented through European collaborations, for example:
On behalf of EuroSIDA in EUROCOORD
- In an oral presentation, Alvaro Borges described how host factors, HIV-specific factors, and co-morbidities all contribute to the risk of fractures and osteonecrosis. In particular, tenofovir use, but not other antiretroviral drug, was an independent risk factor for fractures. On the other hand, no association was found between the use of any of the ARVs and risk of osteonecrosis.
- In addition, Anna Schultze presented a poster showing that the rate of CD4 decline did not differ between ART-naive patients with or without transmitted drug resistance.
- Finally, Leah Shepherd presented a poster showing that, in Europe, the incidence of Hodgkin lymphoma and non-Hodgkin lymphoma vary significantly according to region. This may reflect the differences in long term virological suppression as the result of access to, and availability of, cART.
On behalf of the D:A:D study group
- Camilla Hatleberg participated in the themed discussion on the incidence and risk factors for stoke, sharing that elevated blood pressure, age and low CD4 count were the strongest predictors for both haemorrhagic and ischaemic stroke. As in the general population, elevated blood pressure may be a stronger predictor for haemorrhagic than ischaemic stroke in HIV+ individuals.
- Caroline Sabin presented a poster on the association between abacavir (ABC) use and the risk of recurrent myocardial infarction. D:A:D participants who had experienced a myocardial infarction (MI) (predominantly men), were found have an increased risk of recurrent MI. However, this appeared to be largely explained by greater use of ABC in those with an MI in the earlier years of the study.
- Lene Ryom presented a poster on the association between duration of severe immunosuppression and chronic kidney disease. The relative duration of severe immunosuppression was of greatest importance in persons at low estimated chronic kidney disease risk. These new data support aggressive ART to maintain/restore immune function.
On behalf of IeDEA and COHERE in EuroCoord, Eliane Rohner presented three posters on the global burden and mortality of cancer in HIV
- The first poster showed that women in Southern Africa have a higher Kaposi sarcoma risk than women in Europe, and that this difference could not be explained by HIV-related risk factors. On the other hand, in men, the Kaposi sarcoma risk was similar across regions after adjusting for HIV-related risk factors. This pattern likely reflects different human herpe svirus 8 (HHV-8) risk profiles: while men were at high risk of HHV-8 infection in most regions (MSM or resident in HHV-8 endemic regions), the main risk factor for HHV-8 infection in women was residence in endemic regions.
- The second poster reported that HIV-positive women in Southern Africa and Latin America had a markedly higher risk of invasive cervical cancer than women from North America and Europe, and that rates did not decline with time on ART in Southern Africa. These regional differences were not explained by differences in CD4 counts, age, or year of starting ART, but could be explained by a higher prevalence and incidence of HPV infection and limited access to effective cervical cancer screening.
- Finally, on behalf of IeDEA-SA, COHERE in EuroCoord and TREAT Asia Pediatric HIV Observational Database, the last poster showed that that Kaposi sarcoma risk is substantial in HIV-positive children of sub-Saharan African origin, regardless of whether they live in Africa or Europe. In the absence of measures to prevent HHV-8 infection, ART should be initiated in a timely fashion, before advanced HIV/AIDS stage is reached, to reduce Kaposi sarcoma risk in these children.