Dr. Peter Reiss
Honorary Dr. at the Amsterdam University Medical Center, University of Amsterdam, former President of the European AIDS Clinical Society (EACS) (2008-2012), former Regional Director for Europe and Central Asia on the Governing Council of the International AIDS Society (IAS) (2006-2014), Co-Chair of the 22nd International AIDS Conference (AIDS 2018), Director of the Netherlands HIV Monitoring Foundation, member of the National Institutes of Health/National Institute of Allergy and Infectious Diseases (NIH/NAID) HIV Vaccine Data and Safety Monitoring Board, and member of various committees including CROI, EACS, and HIV Glasgow.
At the APACC 2023 conference, Dr. Peter Reiss was invited to give keynote speeches in several specialized sessions and also presented the “Lifetime Achievement Award” at the conference. Following Dr. Reiss’s insightful presentation on “Improving the Quality of Life for HIV/AIDS Patients,” our publication’s reporter conducted an in-depth interview with him at the conference venue.
Infectious Disease Frontier: Compared to two or three decades ago, how has the life expectancy of HIV/AIDS patients changed today? Do they have higher aspirations for their quality of life?
Dr. Reiss: With the introduction of effective antiretroviral therapy (ART), the life expectancy of HIV/AIDS patients has significantly improved compared to 20 or 30 years ago. The current consensus is that as long as HIV/AIDS patients can access effective treatment promptly, their survival prospects greatly improve, leading to a substantial increase in life expectancy. However, not all patients can reach the life expectancy of the general population, primarily due to late diagnosis and delayed initiation of treatment after HIV infection. Therefore, the focus is on early diagnosis and early treatment of HIV/AIDS, which is a common guideline worldwide. Nevertheless, in many parts of the world, we still face late diagnoses of HIV, and getting these patients into treatment will certainly extend their life expectancy but may still result in a few years’ difference compared to the general population.
Improving the quality of life for HIV/AIDS patients is a crucial aspect of current research. Ensuring viral suppression is one thing, but what’s more important, not only for HIV/AIDS patients but for anyone, is their personal quality of life. Hence, the “Fourth 90” movement was initiated in 2016, which reevaluated the World Health Organization’s definition of health and criticized the “90-90-90” goals, aiming to eliminate the AIDS epidemic by 2030. This study argued that the “90-90-90” goals do not guarantee the overall health of HIV/AIDS patients and proposed adding a “Fourth 90” target specifically focused on improving the quality of life for patients who have achieved viral suppression to undetectable levels. This movement advocates shifting from a “disease-oriented” to a more “person-centered” clinical management approach.
Infectious Disease Frontier: Are HIV/AIDS patients at higher risk for aging, cardiovascular diseases, and other health issues compared to non-HIV-infected individuals? How should individualized management be approached?
Dr. Reiss: This is an intriguing question and a significant part of our research over the past decade. To answer this question effectively, we established a cohort of HIV/AIDS patients, most of whom received antiretroviral therapy and achieved virological suppression. The key question was who to compare them with (as a control group). To assess whether being on ART would put patients at a higher risk, the baseline clinical characteristics of both groups must be as similar as possible, with the control group being HIV-negative. This is what we did. The results showed that the differences between the two groups were much smaller than what people had initially thought, but we did observe some unfavorable conditions for the HIV/AIDS patient group. However, when we conducted more in-depth analyses, we found that not every condition was the same, and there’s no absolute answer to this question; it depends on the specific condition being observed. In general, HIV/AIDS patients are still at a disadvantage, but this is also constrained by many factors, such as how soon the patient is diagnosed with HIV and when they start treatment. What we can affirm is that early diagnosis and effective treatment will narrow the gap between HIV/AIDS patients and non-infected individuals.
Individualized management is a major theme in the medical field, not limited to HIV/AIDS. The main issue is treating patients as “individuals” – not just on a purely medical level but also considering their overall health, listening to and understanding what is important to them (their personal needs), which is all part of “personalization.” In essence, we must go beyond the confines of specialization and provide comprehensive clinical care tailored to an individual’s health needs, requiring multidisciplinary collaborative efforts, including management of conditions like hypertension or diabetes.
Infectious Disease Frontier: Integrase strand transfer inhibitors (INSTIs) have become a crucial aspect of HIV treatment. There is increasing research focusing on the correlation between such drugs and blood sugar, lipids, and cardiovascular diseases. How do you view this research?
Dr. Reiss: INSTIs are part of the new generation of drugs and are recommended as first-line treatments in global guidelines, being widely used worldwide. People noticed the association between INSTIs and weight gain quite early on. Indeed, the correlation between INSTIs and blood sugar, lipids, and cardiovascular diseases is an interesting question because weight gain may be related to increases in cholesterol and blood sugar. However, what the negative implications of weight gain are remains a question yet to be definitively answered. When we carefully consider this, we realize that there is a significant variation in weight gain among individuals, and the ways in which people are at risk of weight gain differ. It’s essential to emphasize that this issue is highly individualized. Therefore, it’s not an absolute reason for individuals to avoid using INSTIs for treatment, but we do need to monitor patients’ weight during treatment and make adjustments accordingly.
