Plenaries Synopses

Introduction to pathophysiology of HIV

Clinical

August 30, 2019 - 9:00-9:30

HIV pathogenesis includes complex host, virus and environmental factors. Approximately 120 years ago, a close ancestor of HIV-1 highly related to current Simian Immunodeficiency Viruses (SIVs), was transferred from monkeys to humans somewhere between the Niger and Congo rivers in West Africa. Natural host defense mechanisms against viral infections like the restriction factors APOBECG, TETHERIN, SAMDH and TRIM-5-alfa failed to protect against such inter-species jump and are insufficient to halt HIV replication today. HIV thrives by infecting precisely the immune cells in charge of eliminating viral infections and subverting the immune system to its own replicative advantage. Moreover, the virus exhibits a huge ability to diversify and generate mutations that allow it to escape from the immune and antiretroviral therapy pressure. The human microbiome might further contribute to HIV pathogenesis by modulating immune activation and chronic inflammation. HIV cure will have to address all these important factors to become a reality.

Speaker: Dr Roger Paredes (Spain)

Drug resistance of HIV

Clinical

August 30, 2019 - 9:30-10:00

The risk of selection of resistant HIV has decreased in high income countries with the introduction of current potent and relatively tolerable ART. In addition to occasional selection of resistance at failure of ART, resistance viruses are being spread in local sexual networks and imported from areas with less frequent monitoring. Also new therapeutic strategies such as PrEP, long acting drugs and maintenance therapy influence the mechanisms of viral escape. The presentation will give basic insight in important aspects of viral quasispecies, dynamics of resistance patterns and evolution pathway and how this knowledge influences clinical decision making.

Speaker: Dr Annemarie Wensing (Netherlands)

State of the ART of ARV therapy

Clinical

August 30,2019 - 10:00-10:30

Currently HIV infection can be controlled long term with potent, safe and convenient antiretroviral therapy that leads to prolonged healthy survival in our patients. This session will cover the current treatment guidelines, explore factors to consider when choosing a regimen and review the newer strategies, formulations and agents that will continue to move HIV treatment forward.

Speaker: Dr Nicola Mackie (United Kingdom)

Why is research important?/Choosing the right study design

Research

August 30,2019 - 11:00-11:30/11:30-12:00

As conducting research has many resource implications, in order to conduct the “best” research that we can and give ourselves the best chance of success, we should identify and defined a clear research question. This will then help us select the most appropriate study design to answer the question. In this session, we will describe an approach to developing a research question and the most commonly used study designs (randomised controlled trials, cohort, case-control and cross-sectional studies), giving examples of each, and will describe their pros and cons.

Speaker: Prof. Paddy Mallon (Ireland)/Prof. Caroline Sabin (United Kingdom)

P-values and hypothesis testing/Confidence intervals

Research

August 31,2019 - 8:30-9:00/9:00-9:30

Presentations of data in the medical world are littered with p-values. But what do these p-values really tell us, and is a P-value <0.05 really that important? In this lecture we will start by illustrating how the P-value can help us to differentiate real findings from associations which may occur by chance. We will then demonstrate the general principal of hypothesis testing, using worked examples to illustrate not only how they can be interpreted, but also some of the problems that may be encountered when relying solely on p-values for this purpose. We will then demonstrate how confidence intervals can be used to supplement the information that is provided by the P-value. Participants will then have the opportunity to put their knowledge into practice using real-life examples from the published literature.

Speaker: Dr Tracy Glass (Switzerland)/Prof. Caroline Sabin (United Kingdom)

Optimizing ART in the suppressed patient

Clinical

August 31,2019 - 10:45-11:25

Treatment strategies have moved forward a key achievement with the universal recommendation to treat any HIV infected individual regardless of CD4. In the absence of any cure/remission strategies long life therapy is a mandatory condition to maintain viral suppression leading to mormalized life and no transmission. As a consequence of earlier initiation therapy in patients with better immunovirological status, using more potent drugs, management of virally suppressed patients has evolved towards reducing drug burden using alternative strategies in order to minimize long term exposure, reducing drug long term toxicity and potentially minimizing costs. Learning the best proven strategies, their benefits and how to individualize ART in different settings is a major issue for HIV physician with the objectives of leading HIV infected individuals towards several decades of suppressive ART taking into account the incident events of life time as aging comorbidities.

Speaker: Prof. Christine Katlama (France)

Management & prevention of co-morbidities

Clinical

August 31,2019 - 11:25-12:05

Despite improvements in life expectancy with effective antiretroviral therapy, people living with HIV still experience excess morbidity and mortality from long-term co-morbidities. These include cardiovascular disease, liver disease, bone disease and cancers. Accumulating evidence suggests that residual inflammation that persists despite treatment significantly contributes to many of these co-morbidities, along with lifestyle factors and contributions from antiretroviral therapy. Understanding the pathogenesis underlying the increased risk of co-morbidities is essential to the appropriate prevention and management of these conditions and ensure successful long-term outcomes for people living with HIV.

Speaker: Prof. Paddy Mallon (Ireland)

HIV & malignancies

Clinical

August 31,2019 - 12:05-12:45

Cancer, both AIDS-defining or non-AIDS-defining cancers (NADCs), has become the leading cause of death in people living with HIV, associated with an increase in the incidence of some NADCs compared to the general population, including lung cancer, hepatocellular carcinoma, head and neck cancers, anal cancer, and Hodgkin lymphoma. Incidence of NADCs should be expected to increase further as the PLWH population continues to age. This session will provide an update on epidemiology and the identification of risk factors to determine the most appropriate prevention and screening strategies in this population. Cancer management in HIV patients is based on general recommendations, with specific attention to comorbidities or drug interactions and some special considerations for cancer treatment in these patients will be discussed.

Speaker: Prof. Stéphane De Wit (Belgium)

Hepatitis B / Hepatitis C

Clinical

September 1,2019 - 8:30-9:15

Liver disease remains a major cause of morbidity and mortality in HIV-positive individuals. This session will provide an update on the epidemiology of viral hepatitis and HIV co-infection. An update on the current management of HBV will be discussed. Directly Acting Antivirals (DAAs) against HCV have revolutionised HCV management. Micro-elimination in subgroups of patients may be a realistic possibility in the near future. However there are barriers that need to be overcome. Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognised problem over recent years. Understanding the pathophysiology and natural history in HIV-positive individuals will be important in order to design optimal management pathways.

Speaker: Dr Sanjay Bhagani (United Kingdom)

Opportunistic infections

Clinical

September 1,2019 - 9:15-10:00

The incidence of opportunistic infections (OI) has dramatically declined with scale-up of effective antiretroviral therapy (ART). However, OI still occur especially amongst HIV infected individuals presenting late to care and in those failing ART. Tuberculosis (TB) is the commonest OI globally. Newer issues in TB include the use of point-of-care tests for diagnosing TB (especially in smear negative and extra-pulmonary situations), clinical effectiveness of use of Rifampicin and Integrase inhibitors and/or TAF, short course regimens for preventing TB, drug interactions amongst anti-TB drugs and ART and advances in management of multi-drug resistant TB. Amongst fungal infections new data on management and prevention of cryptococcosis is interesting. The emergence of histoplasmosis as an important OI in Latin American countries needs to be recognized in individuals presenting with clinically compatible symptoms. This presentation will highlight some important advances in screening, diagnosis and management of common OI amongst HIV-infected individuals.

Speaker: Prof. Sanjay Pujari (India)

HIV prevention strategies

Clinical

September 1,2019 - 10:30-11:15

Transmission of HIV is preventable. Whilst treatment of people living with HIV is key, Pre Exposure Prophylaxis for sexual risk and Post exposure prophylaxis for sexual or occupational risk are both highly effective with well tolerated regimens now available for use. Assessment of risk and additional risk reduction strategies are also important to discuss with high risk individuals. EACS have produced clear guidelines on the management and follow-up for PrEP and PEP. Newer agents/methodologies and different patient populations are being assessed for PrEP so data is continually evolving. Understanding the evidence base for PEP and PrEP is an important part of HIV and Sexual Health Care.

Speaker: Prof. Yvonne Gilleece (United Kingdom)

Developing a clinical research programme

Research

September 1,2019 - 11:15-12:00

There are recognised structures around the design, conduct and reporting of clinical research. Knowledge of this structure permits the researcher to conduct quality research and provides a platform upon which to build research programmes within a disease area. This presentation will offer personal insights from research leaders on how to use knowledge gained through implementation of simple research projects to build progressively larger and more ambitious research projects and ultimately international, collaborative programmes of research.

Speaker: Prof. Paddy Mallon (Ireland)

What to look for in a presentation/paper

Research

September 2,2019 - 8:30-9:15

The plenary session 'What to look for in a presentation/paper' covers the general principles of critically reading a research paper and finding the relevant information in the various sections of the publication, including the title and the abstract, in addition to the text, tables and figures. The presentation is based on the concepts presented in the previous sessions on study design, analysis, and interpretation and is aimed at explaining where to find the key elements in scientific papers or congress presentation. These principles are illustrated using a worked example from the most recent literature in the HIV clinical research domain. Finally, the Equator-network web address including all reporting guidelines is provided.

Speaker: Prof. Dominique Costagliola (France)

Identifying bias

Research

September 2,2019 - 9:15-10:15

When carrying out and appraising research, we must always be aware of any potential limitations of the study. Many studies, particularly observational studies, are related to the potential for bias to occur and therefore we must consider the likely impact of any potential biases on our study. In this talk we will define what is meant by ‘bias’ and will describe several commonly seen biases in the published literature, illustrating each by real-life examples. We will focus particularly on the possibility of confounding bias, as this is particularly problematic in observational studies, and will discuss possible approaches to minimise the impact of any such bias.

Speaker: Prof. Caroline Sabin (United Kingdom)