Ryan Williams

In the age of HAART, U=U and overcoming immunosuppression, many PLHIV are living longer or even (nearly) matched life-expectancies. This session explored some common comorbidities facing PLHIV that are not HIV-related and how these affect their general health. These trials help healthcare workers better understand and address multimorbidity.

Dhanushi Rupasinghe presented a sub-analysis of 20865 patients from the RESPOND trial, investigating the association between increased BMI and DMT2 in patients on INSTI-based HAART regimens. Data showed a 48% increased incidence of DMT2 compared with PIs & NNRTIs and suggested this is not dependent on BMI. Nyasha Dzavakwa reported findings of the VITALITY trial, which explored whether dietary vitamin D and calcium intake is associated with low bone density in peripubertal adolescents living with HIV in Zambia and Zimbabwe. Findings suggested this is the case and strengthen calls for supplementation to be made available. Sherika Hanley presented the results of the ISCHeMiA study, which examined the effect of lifestyle modification advice and annual screening for CVD risk on the prevalence of metabolic syndrome and the impact on other CVD indices in women LHIV. Although a modest improvement in many physiological markers was observed, the course of obesity remained unchanged. Starley Shade reported findings of a study evaluating opioid-related harm associated with stimulant use in people with chronic pain living with and without HIV. Stimulant-positive urine drug tests (UDTs) were associated with subsequent discontinuation of long-term opioid therapy (LTOT) within 90 days, however this trend was less likely among PLWH.

Data continues to highlight the association between HIV and certain ARV regimens with cardiometabolic disorders. People on INSTI-based regimens and women LHIV warrant individually tailored interventions to optimise CVD risk factors - particularly when there are comorbid issues such as endocrine disease or corticosteroid therapy. Evidence-based strategies to improve BMD must be implemented to increase bone health in adolescents LHIV with nutritional deficiencies. The findings of the LTOT trial may have identified a trend that differs in PLHIV from people without HIV, but there is no clear explanation for this and more research needs to be done to explore this.