Aging, ART & Prevention Focus of HIV Update

Myron Cohen, MD, spoke about how men and women metabolize PrEP differently.

Myron Cohen, MD, spoke about how men and women metabolize PrEP differently.

Medical case manager Casey Norton from Triad Health Project in Greensboro was eager to learn more about how the field of antiretroviral therapy is moving from oral medications to injections and even the development of implants.

“My clients are all living with HIV,” Norton said. “To have one day have a treatment that is implanted would be great.”

Norton was one of more than 430 HIV providers from around North Carolina who attended UNC’s HIV Clinical Care update at the Friday Center on May 2. For more than 20 years, Carolina has partnered with the Greensboro Area Health Education Center (AHEC) to provide health care professionals who treat people living with HIV with the latest clinical and research news.

“UNC has taken a leadership role in caring for people living with HIV in North Carolina,” said conference organizer Heidi Swygard, MD, MPH, Clinical Associate Professor of Medicine at UNC. “We teach today and tomorrow’s providers about HIV. We know not everyone can afford to travel to the big conferences, so we ask the experts to present here each year.”

Presenters included many faculty from UNC’s Division of Infectious Diseases. Myron Cohen, MD, Chief of UNC’s Division of Infectious Diseases and Director of the Institute for Global Health & Infectious Diseases, spoke about HIV prevention efforts. He said researchers at the UNC Eshelman School of Pharmacy found that Truvada, a pill to prevent HIV, works differently in men and women. Women need to take this form of pre-exposure prophylaxis, or PrEP, once daily. Men seemed to remain protected with only two doses a week.

Joe Eron, MD, presented a history of antiretroviral therapy.

Joe Eron, MD, presented a history of antiretroviral therapy.

“I didn’t realize PrEP works differently in men and women,” said Renee Rosser, a medical case manager at Triad Health Project. “I would not have known that if I hadn’t come to this conference.”

Cohen also shared that researchers had tested vaginal gels and rings for HIV prevention, but had found adherence played a role in the interventions’ effectiveness. In an effort to take adherence out of the equation, studies investigating long-acting injections and broadly neutralizing antibodies or BnABs to prevent HIV are being led by the HIV Prevention Trials Network.

Joe Eron, an HIV clinician at UNC’s Infectious Diseases Clinic and a Professor of Medicine at UNC, presented a timeline about antiretroviral therapy or ART.

“There are about 35 million people in the world living with HIV,” Eron said. “The goal of ART is to restore and maintain the health of people living with HIV through the suppression of HIV replication.”

Modern day antiretroviral therapy consists of a three-drug combination, although studies are being done to test the efficacy of two-drug combinations, Eron said. He called this the era of integrase inhibitors, a class of anti-HIV medications that are potent, yet well tolerated. Developing new forms of ART, including long-acting injections, is also being explored to help those who develop a resistance to current treatment, to make taking ART and getting pregnant safer, and to prevent any drug-drug interactions for people taking other medications as they age.

David Wohl, MD, went over six ways to age successfully with HIV.

David Wohl, MD, went over six ways to age successfully with HIV.

Speaking of HIV and aging, more than half of the population of people living with HIV in the US are over the age of 50. UNC Professor of Medicine David Wohl, MD, dedicated his talk to this topic.

“Many people think living with HIV accelerates the aging process,” Wohl said. “Aging is very complex and influenced by many factors, including genetics, lifestyle, environment and disease. People living with HIV are at a greater risk for conditions associated with aging, like heart disease and cancer, but I don’t think we can say definitively that having HIV is causing this.”

People living with HIV are twice as likely to smoke, which is a factor that influences heart disease, Wohl said. He shared with the group ways to improve aging with HIV, including starting ART immediately upon being diagnosed with HIV, quitting smoking, knowing heart disease risk factors and getting regular cancer screenings. Wohl said kidney and bone health are also extremely important for people living with HIV as some ART can negatively impact the kidneys and cause bone loss.