Plenaries Synopses

Introduction to pathophysiology of HIV

Clinical

6 September 2022 - 8:45-9:10

 

HIV is a retrovirus targeting key cells from the immune system and causing slowly progressive lethal immune disorders. This lecture will focus on the pathophysiological mechanisms of this disease with special emphasis on HIV receptors and replication cycle in immune cells, mechanisms by which HIV hijacks and escapes the immune responses and induces CD4 lymphopenia and other immune defects and inflammation. Pathophysiological mechanisms involved in immune restoration and benefits of antiretroviral therapy will also be described as well as current views on how to manipulate the immune system to help move forward HIV remission or cure.

 

Speaker: Prof. Brigitte Autran (France)

 

Value of measuring resistance in HIV

Clinical

6 September 2022 - 9:10-9:40

Drug resistance

9:10-9:25

The lecture on HIV drug resistance will guide you through mechanism of selection of resistance. Furthermore, it will address the principle of the genetic barrier to resistance and will take a look at assessing and interpreting drug resistance, the impact of resistance on treatment options and transmitted resistance and evolutionary pathways.

 

Speaker: Dr Annemarie Wensing (Netherlands)

 

State of the ART of ARV therapy

Clinical

6 September 2022 - 9:40-10:05

 

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

6 September 2022 - 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 define 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.

 

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

 

P-values and hypothesis testing/Confidence intervals

Research

7 September 2022 - 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 principle 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.

 

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

 

Optimizing ART in the suppressed patient

Clinical

7 September 2022 - 10:30-10:55

 

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 mormalised 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 minimise long-term exposure, reducing drug long-term toxicity and potentially minimising costs. Learning the best-proven strategies, their benefits and how to individualise ART in different settings is a major issue for HIV physicians with the objectives of leading HIV-infected individuals towards several decades of suppressive ART taking into account the incident events of life-time as ageing co-morbidities.

 

Speaker: Prof. Christine Katlama (France)

 

Management of co-morbidities

Clinical

7 September 2022 - 10:55-11:20

 

Despite improvements in life expectancy with effective antiretroviral therapy, some 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

7 September 2022 - 11:20-11:45

 

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)

 

Guest lecture: From big data and artificial intelligence to artificial results with big mistakes

7 September 2022 - 12:00-12:30

 

“Big data” and “artificial intelligence” are buzz words, first of all. They are truly representing components of a revolution in the world of data science. More information and new methods are generating new opportunities but also noise due to mistakes and sometimes misconduct. Let’s dive and contemplate a couple of examples to illustrate this in clinical epidemiology. 

 

Speaker: Prof. Rodolphe Thiebaut (France)

 

Hepatitis B / Hepatitis C

Clinical

8 September 2022 - 8:30-8:55

 

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 and future 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

8 September 2022 - 8:55-9:20

 

Thanks to antiretroviral therapy (ART) there has been a significant decline in the incidence of Opportunistic Infections (OI’s). However, OI’s still contribute to significant morbidity and mortality in People Living with HIV (PLHIV). Opportunistic infections occur amongst PLHIV presenting with advanced HIV disease either due to delayed HIV diagnosis or failure of ART. There has been a substantial disruption in HIV care during COVID-19 pandemic that may possibly lead to the re-emergence of OI’s because of ART interruptions. There have been significant advances in the diagnosis and treatment of OI’s over the last few years. For treatment of rifampicin susceptible Tuberculosis (TB), short course rifapentine-moxifloxacin- based regimen has shown promise. For rifampicin-resistant/multi drug-resistant TB, WHO recommends an oral short 6-month course of BPaLM regimen irrespective of HIV status. For HIV-associated cryptococcal meningitis, WHO recommends using a single high dose liposomal Amphotericin B (with flucytosine and fluconazole) that has significant potential to simplify treatment and avert costs. Minimally invasive tests have shown promise in diagnosis of PJP that may reduce the need for invasive respiratory sampling. Histoplasmosis is often underdiagnosed in endemic regions due to close clinical resemblance to TB. Voriconazole has the potential to be used for the induction treatment of HIV-talaromycosis. Some of the recent advances in the diagnosis and treatment of select HIV-OI’s will be discussed during the presentation. 

 

Speaker: Prof. Sanjay Pujari (India)

 

HIV prevention strategies

Clinical

8 September 2022 - 9:20-9:45

 

Knowledge about HIV prevention is essential to help reduce new HIV transmissions and diagnoses and includes 

• Expansion of HIV testing 
• Treatment as Prevention (TasP) 
• PrEP (pre-exposure prophylaxis)  
• Condom use 
• Circumcision 
• PEP/PEPSE (post-exposure prophylaxis) 
• Vaccination 

This session will give up-to-date clinical trial and cohort information on HIV prevention strategies for men, women and transgender people at risk of HIV. 

 

Speaker: Prof. Yvonne Gilleece (United Kingdom)

 

Developing a clinical research programme

Research

8 September 2022 - 10:30-10:55

 

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)

 

Identifying bias

Research

8 September 2022 - 10:55-11:20

 

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)

 

Writing papers/abstracts

Research

8 September 2022 - 11:20-11:45

 

Writing good manuscripts that will be accepted for publication is a skill that can be developed with a bit of practice and some guidance. Most published papers have a fairly similar structure, ensuring that readers know where in the manuscript they should look to find specific information. Journals also provide specific guidance for their own publications.  In this lecture, we will look at the structure of manuscripts and give tips on how to approach your writing, and suggest materials that can help to support you in this endeavour.

 

Speaker: Prof. Dominique Costagliola (France)