Editor’s Note:
The 12th International AIDS Society Conference on HIV Science (IAS 2023) was held from July 23-26, 2023, in Brisbane, Australia. As the largest open scientific conference in the global field of HIV/AIDS, it attracted the participation of experts, medical professionals, community organizations, and healthcare companies worldwide. Dr. Wei Cao from Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, was invited to attend the conference and was interviewed on-site by Infectious Disease Frontier. We have invited Dr. Cao to share the latest developments emerging from this conference and hot topics related to HIV/AIDS treatment.
01 Latest Developments at IAS 2023 Conference to Advance HIV Clinical Practice
Dr. Cao: The IAS 2023 conference focused on current HIV treatment concepts and new perspectives on long-term patient management. On the one hand, in terms of treatment drugs, although there have been no major groundbreaking medications, long-acting treatment drugs have garnered unprecedented attention in the long-term management and prevention of AIDS. In the future, we can expect long-acting treatment drugs to bring about a new revolution in the field of AIDS.
On the other hand, personalized selection of antiretroviral therapy (ART) is receiving increasing attention. For instance, in clinical practice, we often encounter AIDS patients with other comorbidities or those with prior treatment experiences. Choosing an appropriate treatment plan for such patients is a major focus of this conference.
Furthermore, with the continuous progress of ART, HIV infection has gradually become a manageable chronic disease. For long-term HIV survivors, there is a tendency to develop “non-AIDS complications,” including cardiovascular diseases, osteoporosis, kidney diseases, and other common health issues related to aging. This has received significant attention at this conference. We noticed that the latest study published in the NEJM journal, the REPRIEVE study, showed that HIV patients taking statins daily had a 35% reduction in the risk of major adverse cardiovascular events (MACE), including heart attacks and strokes, as well as cardiovascular death, compared to the placebo group. The observed adverse drug events were similar to those seen in the general population taking statins, demonstrating good safety. The results of this study will have a significant impact on future guidelines and clinical practice.
In summary, the many latest developments emerging from this conference will further enhance our understanding of AIDS treatment and prevention of AIDS-related complications. In the future, they may also change clinical practices in various countries and regions worldwide.
02 Tailoring Tuberculosis Prophylaxis in Adult HIV-Infected Patients According to Local Context
Dr. Cao: This issue depends on different countries and regions. For example, in Western countries, some major clinical studies and guidelines recommend active tuberculosis prophylaxis for those identified as having latent tuberculosis infection. However, in China and many developing countries, the question of whether to implement universal or widespread tuberculosis prophylaxis still requires further discussion and individual patient considerations. In China, there are a significant number of AIDS patients with latent tuberculosis or a history of tuberculosis infection, especially when they are in an immunosuppressed state. Whether to initiate tuberculosis prophylaxis indiscriminately for all of them is a matter of debate. In our clinical practice, we selectively provide prophylactic treatment to higher-risk populations.
03 Managing Weight Gain During Antiviral Therapy
Dr. Cao: Concerning weight gain in HIV-infected individuals, whether associated with integrase strand transfer inhibitors (INSTIs) or not, it has become an important health issue in long-term AIDS treatment. In recent years, both the IAS conference and the Conference on Retroviruses and Opportunistic Infections (CROI) have shown widespread concern on this issue. To date, I believe weight gain is related to many factors, including diet, exercise, emotional well-being, and even the management of patients’ lifestyles. Whether weight gain during HIV treatment can be attributed to INSTIs or other medications is still a matter of debate.
While some studies have suggested that INSTIs may lead to a higher trend of weight gain compared to previous ART drugs, many of these studies did not adequately account for other factors influencing weight, such as diet and exercise. Therefore, we should critically interpret these results. At least for now, weight gain is not considered a factor in the selection of existing drugs in HIV guidelines in any country or region. Clinically, we do not influence patient treatment choices based on reports of weight gain. Therefore, the majority of experts and scholars believe that more detailed and accurate observational research is needed in this field to reach a final conclusion.
Regarding clinical recommendations for weight management during treatment, I believe we should start with a broader perspective that includes factors influencing weight, such as diet control and the management of underlying conditions. Many patients who gain weight during ART treatment actually have comorbid metabolic diseases such as type 2 diabetes and high cholesterol. If we can control these underlying conditions that are relevant to the patient, weight issues are likely to be resolved to a large extent.
On the other hand, there are ongoing clinical studies in different regions on switching medications, primarily replacing INSTIs, which tend to result in greater weight gain based on clinical data, with drugs that have less impact on blood lipids and weight, such as non-nucleoside reverse transcriptase inhibitors (NNRTIs) and new-generation protease inhibitors (PIs). However, as mentioned earlier, when it comes to patient weight management during treatment, our first consideration should be whether the patient has comorbid underlying conditions, lifestyle management, and whether drug effects are involved. Further observational research is needed to support any drug transitions.
04 Impressions and Takeaways from Attending IAS 2023
Dr. Cao: In the past three years, while advances in communication technology have greatly facilitated our academic exchanges, there have still been some limitations in terms of the collision of academic ideas, communication of opinions, and cooperation. Therefore, face-to-face communication and exchanges among individuals remain essential for the advancement of our academic field. We are delighted to see that, after three years, everyone has resumed in-person academic exchanges. The IAS 2023 conference adopted a combination of online and in-person formats and had the highest number of participants in recent years. Through this conference, we learned about significant shifts in AIDS management concepts and the latest clinical advancements in AIDS treatment. We hope that in future IAS conferences, more and better Chinese research will emerge to represent our country on the global stage.
