I recently attended the Conference on Retroviruses and Opportunistic Infections with 4000 other HIV specialists and researchers. Here are some things I learned.
LONG ACTING INJECTABLE ANTIVIRALS STILL WORKING
Injectable Cabotegravir and Rilpiverine are still proceeding in trials and look promising to get an injection once a month. In fact, a study showed that many patients would prefer an injection once a month to pills. This is especially good for those who want to keep their HIV a secret. But, many might miss their injection appointments and not put a high priority on it as I saw years ago, with monthly pentamidine treatments to prevent Pneumocystis pneumonia.
FREQUENT HIV TESTS HELPFUL
When HIV establishes an infection, the defensive cells try to fight it off, even if a person is on antivirals and the amount of virus in the blood is undetectable. These cells put out chemicals called cytokines to bring in more defensive cells. These chemicals are a measure of inflammation since they also cause acceleration of the narrowing of our arteries (brain=stroke, heart=attack, kidneys=failure). Patients who had a delay in treatment had more (unrelated to HIV type-) cancers many years later as compared to those who were treated early. So being checked every 6 months if at risk for HIV is best so that the infection can be caught early to keep these chemicals to a minimum=slow the speed of arterial narrowing and prevent cancers. It is strange that most catch HIV without any symptoms: sore throat, fever, flu-like illness, rash, big lymph nodes).
If you are on PrEP then you are probably being checked for HIV every 3 months. Make sure you are checked in all sexual parts for STIs (sexually transmitted infections): gonorrhea and chlamydia too and your blood for syphilis since they are present many times without symptoms and can cause damage to more than your sex parts if untreated. Your risk is much higher for the STIs when condoms are not used.
HORMONE PILLS DON’T HURT
For your sisters, girlfriends, transgender women: Being on hormones did not affect their ability to infect others or lower the effect of the antiviral medications.
VIRAL LOAD >1500 CAUSES TRANSMISSION
They found that those with a viral load more than 1500 caused higher risk of HIV transmission compared to those with lower viral loads, assuming no PrEP or condoms were used.
RESEARCH ON PATIENTS SHOULD HAVE PATIENT INPUT
There is booklet that describes how to conduct research with patients that respects their input and participation in all stages of the research. http://www.avac.org/good-participatory-practice This is the way research is going since many feel that research guided only by the scientists may not be as important for society unless patients agree that the goals are important. Most large universities have Community Advisory Boards but many research institutions do not. I have been involved with this type of research for the last 3 years and it is rewarding knowing that patients are helping to guide the plans.
To control epidemics of sexually transmitted infections, including HIV much studying has been done on mapping of contacts and their contacts, i.e. a network or web. These maps are complex and very interesting. Let’s say you are having sex with 3 people, and one has sex only with you, the other has sex with someone beside you and the last has sex with 3 others beside you. Then each of their partners has a different number of whom they have sex with, and on and on. Monogamy is a very simple map with 2 dots and a line between them compared to this other map. Some say, “You are not having sex with this person, but with the persons they had sex with.” Condoms really cut down the number of STI transmissions.
HIV-2 MORE FACTS
HIV-2 is from mainly in West Africa in the Sooty Mangabey, where as our good friend HIV (HIV-1) is from the Chimpanzee from the other regions of Africa. Only about 25% of those with HIV-2 will progress to AIDS (bad infections or cancers) and they do it at higher CD4 counts than HIV-1. We should treat all of these, since like HIV-1, the chronic fighting of the immune system against it causes early hardening of the arteries.
TOO THIN OR TOO FAT FOR HIV
Being too thin with HIV causes cancers and hardening of the arteries, and being obese causes these and diabetes and even more cancers along with fatty liver disease.
FATTY LIVER DISEASE
Is becoming the main reason for cirrhosis and liver transplant now that Hepatitis C can be cured. If you have this, using one of the INSTIs (in Stribild®, Genvoya®, Triumeq®, Tivicay®, Issentress®) can reverse it, according to one study. Being on Atripla® is probably bad if you have fatty liver disease.
Be Safe! Wear protection. Get tested. Keep those questions coming.
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV Specialist, Assistant TB Physician, Riverside County Public Health Department
Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center
Member, Coachella Valley Clinical Research Initiative