What did you miss on ageing and co-morbidities from CROI 2020?

Image: Domizia Salusest | www.domiziasalusest.com

An enormous quantity of important and fascinating HIV research is presented each year at the Conference on Retroviruses and Opportunistic Infections (CROI). We have published almost 40 news articles from this year’s conference. As it is hard for anyone to keep up, here is a round-up of the news on ageing and associated health problems in the people living with HIV from the conference.

HIV-positive people who start HIV treatment promptly and have good access to medical care have the same life expectancy as their HIV-negative peers, but they live with additional health problems for many of those years. In an American study, they had major co-morbidities an average of 16 years earlier than HIV-negative people.

Weight gain after starting HIV treatment is likely to raise the risk of diabetes but does not push up the risk of heart disease. The two studies reported are some of the first to shed light on the potential implications of weight gain linked to modern HIV treatment, especially the drugs dolutegravir and tenofovir alafenamide.

Glossary

fibrosis

Thickening and scarring of connective tissue. Often refers to fibrosis of the liver. See also ‘cirrhosis’, which is more severe scarring.

human papilloma virus (HPV)

Some strains of this virus cause warts, including genital and anal warts. Other strains are responsible for cervical cancer, anal cancer and some cancers of the penis, vagina, vulva, urethra, tongue and tonsils.

opportunistic infection (OI)

An infection that occurs more frequently or is more severe in people with weakened immune systems, such as people with low CD4 counts, than in people with healthy immune systems. Opportunistic infections common in people with advanced HIV disease include Pneumocystis jiroveci pneumonia; Kaposi sarcoma; cryptosporidiosis; histoplasmosis; other parasitic, viral, and fungal infections; and some types of cancer. 

insomnia

Sleeplessness.

diabetes

A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

There was some good news about treatment for abnormal cell changes that could be a precursor to anal cancer. In a small study, anal lesions caused by human papillomavirus (HPV) were cleared by a drug that is already approved for the treatment of myeloma, a blood cancer. 

Fatty liver disease, which occurs when fat builds up in liver cells, appears to be more severe in people with HIV than in the general population. Rates of liver fibrosis (a ‘stiff’ liver) and a worsening of fibrosis were high in a US study.

Turning to heart health, a study found a link between testosterone replacement therapy and atherosclerosis. HIV-positive men using testosterone injections or patches had a greater and faster build-up of plaque in their arteries than men not taking testosterone.

Also, insomnia (difficulty falling or staying asleep) was associated with heart attack in people living with HIV, but this was only relevant for one of the two main types of heart attack.

Finally, in terms of damage to the lungs, people living with HIV under the age of 50 lose lung function faster than HIV-negative people of the same age. Action to stop lung damage – such as stopping smoking – should be taken promptly. In those over the age of 50, results were similar between HIV-positive and HIV-negative people.