Top 5 stories on co-infections and co-morbidities in people with HIV from IAS 2023

Cardiovascular and metabolic health was a major theme at the 12th International AIDS Society Conference on HIV Science (IAS 2023) which took place in Brisbane in July. This round-up from the conference also includes key studies on mpox and COVID.

The REPRIEVE study found that pitavastatin lowers risk of cardiovascular events in people living with HIV with low or moderate risk for cardiovascular disease (CVD) who would not usually be prescribed a statin. The rate of major cardiovascular events was 35% lower in the pitavastatin arm compared with the placebo arm. People living with HIV are at greater risk for CVD, but scoring tools developed for the general population can underestimate their risk. Researchers are now recommending the guidelines on statin use be changed. However, when thinking about implementing these findings in the real world, there needs to be consideration of factors such as race and gender, as well as a potential increased risk of diabetes.

Two studies found that switching away from integrase inhibitors did not reverse weight gain, and instead, people who switched continued to gain weight at a similar rate to those who didn’t. One study looked at weight changes following a switch to a protease inhibitor-based regimen, the other following a switch to doravirine/islatravir. Researchers noted that in the future, managing weight gain could be very important for preventing metabolic disorders in people with HIV. This may include pharmaceutical interventions, but these are expensive, and studies looking at their effects on people living with HIV are needed.

The development of high blood pressure (hypertension) after starting antiretroviral treatment in sub-Saharan Africa is common, and there are calls for its diagnosis and treatment to be funded as part of HIV treatment programmes. In multiple studies presented at IAS 2023, taking an integrase inhibitor and/or tenofovir alafenamide was linked to hypertension. Although hypertension can be managed with monitoring and low-cost generic drugs, this treatment is not always available to everybody.

People with HIV remain at higher risk of dying from COVID-19 in the Omicron era according to a new analysis that compared outcomes after hospitalisation during three waves of the pandemic. It found one in five people with HIV admitted to hospital with COVID-19 died during the Omicron wave compared to one in ten people without HIV. A CD4 count below 200 raised the risk of death by 52% to 79%, but across all three waves, older age was the strongest risk factor. Vaccination was associated with a 39% lower risk of dying after hospital admission in the Delta wave and a 38% lower risk in the Omicron wave.

Qualitative research exploring Australian gay and bisexual men’s experiences of mpox has found that most had highly distressing experiences due to severe symptoms, long isolation periods, and stigma from healthcare providers. Most men reported inadequate pain management, judgemental attitudes, and traumatic experiences. Many participants expressed concerns about their visible lesions and scars. One year on from the outbreak, many had ongoing issues, both physically and mentally, including effects on their sex life and self esteem.