UK-CAB 25 - Background

11 April 2008

Programme

9.45-10.00
Welcome, announcements

10.00-10.30
Conference feedback : key studies from CROI 2008
Simon Collins, HIV i-Base

10.30-12.45
D:A:D study: long-term cardiovascular risks of ARVs, reading study results - some applied statistics
Simon Collins, HIV i-Base and Dr Caroline Sabin, Reader in Medical Statistics and Epidemiology, Department of Primary Care and Population Sciences, Royal Free (with coffee break)

12.45-14.00
Lunch

14.00-15.00
GlaxoSmithKline

15.00-15.45
BHIVA treatment guidelines: new draft
Gary Brough, UK-CAB treatment guidlines writing group rep

15.45-16.00
UK-CAB business

16.00
Close

Background reading

CROI 2008

This conference, always held in the US, is probably the most important scientific HIV meeting held each year.

The 15th CROI (Conference on Retroviruses and Opportunistic Infections) was held in Boston this February.

HIV i-Base - CROI 2008: non-technical summary of 25 studies and presentations.

www.i-base.info/htb/v9/croi08/index.html

Includes:

Benefits of continuous treatment and earlier treatment Generally, many studies are showing an overall benefit of treatment, especially once viral load is undetectable (less than 50 copies/ml). These study results are behind recent guidelines recommending starting treatment a bit earlier.

Atazanavir/r vs lopinavir/r (Kaletra) as first treatment A large (almost 900 patients), randomised, international study (CASTLE) compared atazanavir/r to Kaletra (lopinavir/r) and found both drugs had similar results in people using treatment for the first time.

Side effects: abacavir and risk of heart attack The large prospective D:A:D cohort study (33,000 patients followed for an average of 7 years) reported current (or recent) use of abacavir was linked with an additional 90% increased risk of cardiovascular disease (heart attack).

Side effects: aging, bone disease A plenary session on HIV and aging highlighted that bone mineral density is lower in HIV-positive people.

Very low rates of mother-to-child transmission in the UK Only 3 cases of transmission in 1,341 out of 2,200 HIV-positive pregnancies in women on HAART whose viral load was <50 copies/mL.

Report also covers new medications, risk of sexual hepatitis C reinfection in gay men in the UK, other studies about HIV and hepatitis C coinfection, dug resistant TB and HIV, vaccine research and an interesting case report on an HIV-positive man who received a stem cell transplantation from a donor who was immune to HIV infection.

Aidsmap - News from the 15th CROI Conference, Boston

www.aidsmap.com/cms1174967.asp

Includes:

Kivexa and Truvada have similar efficacy and safety
Region of origin and gender significant in long-term changes in CD4 cell count during effective HIV therapy
Recreational drug use a risk for asymptomatic heart disorders in HIV-positive patients
Risk of lymphomas depends on cumulative viral load and latest CD4 counts
Untreated HIV-positive individuals have a higher risk of death even at CD4 counts over 350
Delaying HAART while treating opportunistic infections increases the risk of disease progression and death
Darunavir found effective and tolerable in treatment-experienced children and adolescents at 24 weeks

Plus many reports on treatment in developing countries.

BHIVA - CROI feedback presentations

www.bhiva.org/cms1222033.asp

Presentations in PDF format: highlights, epidemiology, transmission and testing, antiretroviral treatment strategies, HIV drug resistance, complications of disease, coinfections, pharmacology, women, adolescents and older people.

Aidsmeds - News from CROI 2008

www.aidsmeds.com/archive/currentNews_2151.shtml

Short, news-style reports of key studies.

D:A:D study

www.cphiv.dk/DAD/tabid/57/Default.aspx

The D:A:D study aims to assess the incidence of myocardial infarction (how often heart attacks happen) among HIV-positive people on HAART. The study also looks at whether treatment with anti-retroviral drugs is associated with development of cardio-vascular disease and long-term side effects.

Simon Collins, community representative on the D:A:D steering committee, and Caroline Sabin, author of a key analyisis on the increased risk of heart attack from abacaivr and ddI, will present and discuss the study's findings. This will look at both the results and understanding some of the statistical ideas behind them.

D:A:D stands for Data Collection on Adverse events of Anti-HIV Drugs. D:A:D is a large international observational study of HIV-postivie people under active follow up. The study is coordinatd by the Copehagen HIV Programme. It began in 2001.

Important results have been reported in the last 2-3 years.

D:A:D cohort finds increased risk of heart attack in people taking abacavir or ddI Aidsmap

D:A:D study shows that PIs rather than NNRTIs drive the previously reported cardiovascular risk of combination antiretroviral therapy HIV i-Base

Abacavir, didanosine associated with higher heart attack risk The Body - Interview with Jens Lundgren, MD, Director, Copenhagen HIV Programme

D:A:D steering committee statement on increased risk of heart attack from abacavir and ddI The Body

BHIVA treatment guidelines

UK-CAB members may download a complete draft (and make comments) via the discussion forum

Draft BHIVA treatment guidelines (members only) UK-CAB message board (log in to view)

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