Update From The Latest Hiv (And Hepatitis C) Conference

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“The Conference on Retroviruses and Opportunistic Infections (CROI) is a scientifically focused meeting of the world’s leading researchers working to understand, prevent, and treat HIV/AIDS and its complications. The goal of CROI is to provide a forum for translating laboratory and clinical research into progress against the AIDS epidemic. Over 4,000 leading researchers and clinicians from around the world convene in a different location each year for the Conference. “ I attended it in Atlanta, Georgia in early March. There were over 1,000 posters on Wednesday; I assume that many on Monday and Tuesday. Much research is being done!

To attend, you must have recent journal articles published or be a teacher of HIV.
I ran into many old friends, learned much, and am very grateful to the County of Riverside (my job) paying for the trip.

Here is a summary of new items I learned:
Depression seemed to be lower on patients on antivirals compared to those not on them, even when they looked at patients on efavirenz (in Atripla™). In the past, depression was thought to be higher in efavirenz patients compared with other antivirals. Another study by my friend, Scott Latendre at UCSD, found that those on efavirenz had more risk of mental function, especially in those with HIV and Hepatitis C.

Maraviroc (Selzentry™) seemed to improve mental function, especially speed.
Giving a year of antivirals very early in the HIV infection did not postpone the time that antivirals were definitely needed in the future.

For those on Reyataz™ and having trouble with the Norvir™, one group found that taking the Reyataz™, 200 twice daily, resulted in good viral control, even with Truvada™ (Tenofovir in Truvada™ lowers Reyataz™ levels).

A study of French women found the HIV positives had 3 times the amount of HPV (Human Papilloma Virus, venereal warts) than the HIV negatives and that this could easily be tested in the urine so that a swab in the vagina wasn’t needed.

Obesity seemed to help control HIV better. Maybe the fat gets saturated with the antivirals and leaks out slowly, giving a constant, good blood and tissue level to kill the virus.

Frailty (getting old and weak) is defined as: three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. It seems to happen earlier in HIV patients as do heart attacks. (stop smoking)

Pre-exposure Prophylaxis (PreP) with Truvada™ has been discussed in the past here for a couple with 1 HIV positive member. Maybe it can be discontinued when the couple decides to use a condom or stop wanting to get pregnant, or the HIV positive partner is out of town.
Even those on Kaletra™ with about 1/3 of patients with no virus in the blood detected, had virus in the genital secretions (wear a condom).

Men having sex with men (MSM) are better at transmitting and receiving the virus, nearly with each sex act. They also have very efficient sexual networks to spread the virus among many, fast. Young MSMs worldwide are getting infected very fast and easily. Think how fast HIV can spread if most young MSMs have 2 or 3 partners and are sexually very busy.

In areas of Africa where there are limited medications, Kaletra™ worked well alone for most, without help from Truvada™ or Epzicom™.

HEPATITIS C
It can be sexually re-transmitted by men to men after a cure with medications; some have gotten it again (superinfection)! This was proven by seeing different genotypes and genetics of the second infection from the first. The second infection is usually a different genotype from the first, so there must be some immunity to the first genotype. There are six genotypes so don’t even think of getting each one after taking the treatment each time; one treatment is enough hassle already.

Higher marijuana smoking may accelerate decline of the liver to cirrhosis (liver replaced by scar tissue and not very functional).

When the HIV is not controlled, the liver disease of Hepatitis C progresses rapidly.
The CD4s do not rise as fast or as high in those with Hepatitis C. Get it cured soon! Let your immune system deal with only one disease.

Cardiovasulcar risk (heart attacks and strokes) were lower after the Hepatitis C was cured.
Hepatitis C caused more risk of kidney disease/failure whether they were cured of the Hepatitis C or not.

If you have cirrhosis from Hepatitis C, then you are at risk for liver cancer. This risk doesn’t go away even though your Hepatitis C is cured. They suggested an ultrasound every 6 months forever, not just the old blood test, alpha feto protein, which misses some of the cancers.

HEPATITIS B
Is harder to control with Truvada™ if the patient took Epivir™ (3TC) alone, in the past.
There have been cases of flares of Hepatitis C when a patient was taken off Truvada™ or Epivir™ (3TC) but a study showed that being off 12 weeks resulted in no flares.

Keep those questions coming. Be Safe!
Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside
HIV Researcher, Desert AIDS Project

References: My notes from the abstracts and presentations from CROI

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