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Aging & Comorbidities at ICAAC 2015 & IAS 2015
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ICAAC 2015 55th Interscience Conference on Antimicrobial Agents and Chemotherapy
September 5-9, 2015, San Diego, CA
HCV/HIV Coinfection
Safety of Ledipasvir/Sofosbuvir with and without Ribavirin for the Treatment of Patients with Chronic HCV Genotype 1 Infection: An Analysis of the Phase 3 ION trials - (09/25/15)
No Difference in Safety Profiles Comparing 12- and 24-Week HCV Treatment Durations in HCV Genotype 1 and HIV-1 Co-Infected Patients: Results From TURQUOISE-I - (09/25/15)
TAF
ICAAC: Switching From Atripla to a Tenofovir Alafenamide-Based Single-Tablet Regimen: Week-48 Data in Virologically Suppressed Adults - (09/21/15)
ICAAC: Safety of Once-Daily Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide in Participants With Glomerular Filtration Rate <50 mL/min: 48-Week Results - (09/21/15)
Better HIV Control, Better Bone Changes After Switch From Atripla to E/C/F/TAF - Written by Mark Mascolini - - (09/21/15)
Switch From Raltegravir to Rilpivirine Regimen Safe, Effective in Cohort Study - Written by Mark Mascolini - - (09/21/15)
E/C/F/TAF Kind to Kidneys of People With Stable Renal Impairment - Written by Mark Mascolini - - (09/21/15)
ICAAC: Doubled Hypogonadism Rate in Middle-Aged Men With HIV--Fat Is a Factor - Written by Mark Mascolini - - (09/21/15)
ICAAC: Kinetics of release of antiretroviral drugs through a silicone vaginal ring..... Preliminary Results of a non-toxic Silicone vaginal ring to deliver antiviral drugs, protect women against HIV & herpes - (09/24/15)
ICAAC: Comorbidities of Patients with Human Immunodeficiency Virus (HIV) in the USA - a Longitudinal Analysis of Prevalent HIV Patients Over 11 Years - (09/24/15).......
ICAAC: Alarmingly High Comorbidity Rates Among HIV+ - (09/24/15)
ICAAC: HIV Hospital Mortality Flat From 1993 to 2013, But Non-AIDS Death Rate Surges...... Over that period the proportion of in-hospital deaths attributable to non-AIDS causes rose from 43% to 70.5% (P < 0.0001) - written by Mark Mascolini - (09/25/15)
ICAAC: Population Pharmacokinetic Assessment of Factors Associated with Tenofovir Clearance in Pregnant and Postpartum Women with HIV infection in IMPAACT P1026s - (09/28/15).......Lower Tenofovir Levels in Pregnant Women Taking a Boosted PI - written by Mark Mascolini - (09/25/15)
Comorbidities, Aging & Increased Drug-Drug Interactions:
ICAAC: Relationship between Type of Antiretroviral Therapy, Drug-Drug Interactions, and Hospitalizations - - (09/25/15)......
Contraindicated Drugs Combos Tied to Higher Hospital Rate in HIV+ Veterans - written by Mark Mascolini - (09/25/15)
ICAAC: FIB-4 Linked to All-Cause Mortality in Large Italian HIV/HCV Cohort - Written by Mark Mascolini - - (09/21/15)
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Aging/Comorbities at IAS - (08/18/15)
- 2 TAF studies
- study found that bone loss persists after the first 2 years after starting ART & bone loss persists for 7 years, as long out as study goes, and this is contrary to what all other studies have recently reported
- "Eliciting Cognitive Difficulties...." reports qualitative reporting of cognitive difficulties HIV+ are experiencing & I think importantly puts a better "real--life" understanding to what patients experience, living with HIV is not as easy as many think & these cognitive difficulties reported by patients reflect some of the real-life difficulties!
- study on telomere length reports how early after HIV infection telomere shortens and this reinforces what authors conclude but many studies previously reported that - cellular aging (immunosenescense) occur soon after HIV infection!
- from the VA indicating the poor bone care patients received in VA, study ended in 2010 - patients in this study were not receiving DEXA scan, only 7.3% recd DXA scan, only 16% had Vit D levels measured, pretty astonishing at this point
- 2 studies finding subclinical cardiac strain in HIV+ in the USA & 2nd study in Africa highlighting that the aging issue is global, these studies find a high prevalence of subclinical cardiac strain that are associated with inflammation & immune activation & these findings are "independent of CD4 & undetectable viral load" reinforcing what has been a loud major discussion in recent years at CROI that heart disease & of note subclinical heart disease hangs over as a major concern for HIV+ and particularly for aging/older HIV+ and even with normal CD4 & undetectable viral load the specter of heart disease is a difficult one because these data suggest just taking all the regular precautions like lowering lipids, healthy diet & exercise may not be enough to normalize the risk HIV+ face compared to HIV-negatives; of course a healthy diet & exercise will help but it may not be enough to normalize the risk HIV+ face vs HIV-negatives
- current substance abusers had higher risk for comorbidities, we know many HIV+ are current substance abusers, this study also found higher inflammation markers are associated with increased risk for comorbidities
- an interesting question is - for newer/younger patients who started ART at higher CD4s at 500 or so - will their risk for comorbidities, for accelerated aging be the same as the older generation who started ART with low CD4 nadir? Starting ART earlier certainly will decrease risk but clearly HIV damages the immune system upon infections, studies show immediate ART during acute infection lessens the damage but does not eliminate it - the damage is done, is not preventable but ART when CD4 is higher is helpful.
- study reporting HIV+ with asymptomatic neuro impairment are more likely to go on to symptomatic impairment suggesting that many HIV+ may not realize they have neurologic or cognitive impairment but they may have it, and I think this reflects a real-life scenario, that many HIV+ who are younger 25-50 yrs old may not realize they do have some cognitive impairment, but as the study finds these patients were more likely to develop symptomatic neurologic impairment; this is one of several major concerns aging HIV+ face - cognitive/neurologic impairment, heart disease, mobility problems that reflect gait impairments & frailty onset & this will result in more falls & fractures - all the literature in the general literature reports older people who fall & experience a fracture - it is very difficult to recover, mortality rates increase for these patients who are older & fall - after any person reaches about 64 yrs old the immune system changes, it degrades, and recovery from hard "hits" like this is very difficult. Not to mention depression & suicide. In my discussions with clinicians who have large HIV practices over 50% of older HIV+ are on anti-depressants, many younger patients take ADHD drugs & other drugs for sleeping, making it very difficult to understand the future for patients regarding cognitive impairment as they progress to older age. No matter how you cut it in general HIV+ individuals as it is generally accepted experience about 10 years accelerated aging vs HIV-negatives reflecting why AGING & HIV needs a lot of attention, much more than it gets, issues include loss of income, housing, depression, mobility, suicide.
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