Title

In it together: Co-infections in people living with HIV (CME)

Code

SY55

Session Type

Symposium

Track

Track A: Basic science

Channel

Channel 2

Date Time

21 July 14:00- 14:50

Local Date Time

14:00 - 14:50 W. Europe Daylight Time

Moderator:

Penny MOORE, University of the Witwatersrand, South Africa

As we continue to make great strides in HIV treatment, many questions must still be addressed on treating co-infections in people living with HIV. Research into HIV and co-infections must be intensified, particularly as more people are ageing with HIV, which is when more co-infections might occur. A greater understanding of the immunological modification in co-infected individuals is needed. This session will look at these issues at the molecular level and improve our understanding of how they can be addressed.

2 min	Introduction Penny MOORE, University of the Witwatersrand, South Africa

10 min	Immunological modification in HIV/SARS-CoV-2 coinfected individuals Alex SIGAL, Africa Health Research Institute, South Africa

10 min	Microbiome and HIV Nichole KLATT, University of Minnesota, United States

10 min	Impact of CMV on HIV outcomes Peter HUNT, University of California San Francisco, United States	Slides

18 min	Live Q&A Peter HUNT, University of California San Francisco, United States Alex SIGAL, Africa Health Research Institute, South Africa Nichole KLATT, University of Minnesota, United States Penny MOORE, University of the Witwatersrand, South Africa

AUTHOR

Marta Massanella

SUMMARY

This session, chaired by Penny MOORE, addressed the consequences of some viral co-infections and microbial dysbiosis in inflammation, and their impact in co-morbidities and different risk factors. All these factors may impact HIV acquisition, transmission or persistence.

HIGHLIGHTS

Alex SIGAL showed that PLWH present more severe COVID-19 (requirement of supplemental oxygen) only during the ß variant infection wave, but it is not associated with higher mortality. In a case report study of an HIV-infected individual, SARS-Cov-2 evolved intra-host, leading to escape mutations from neutralization similar to VOC. Nichole KLATT demonstrated that dysbiotic bacteria can metabolize some PrEP drugs, reducing its efficacy. Importantly TAF is not degraded by vaginal bacteria, and could be used for more efficacious PrEP. Therefore, vaginal dysbiosis leads to local inflammation, epithelial barrier damage and altered ARV-metabolism leading to increase susceptibility of HIV acquisition and transmission. Peter HUNT presented several deleterious effects of CMV co-infection in PLWH, including increased immune activation, adipose tissue inflammation, non-AIDS events, venous thromboembolism, neurocognitive impairment, larger HIV reservoir, among others. Valgancioclovir reduces immune activation in treated HIV, and corresponds to markedly reduced risk for MI and T2DM.

CRITICAL ASSESSMENT

ART is a lifesaving treatment, but inflammation remains increased in PLWH despite suppressive ART. Several mechanisms could account for this increase, such as co-infections (i.e., CMV) and microbial dybiosis. Chronic disease can cause a vicious cycle of inflammation and damage and more inflammation, being the cause and the consequence of several deleterious effects and comorbidities. Several treatment interventions for vaginal dysbiosis and CMV are now on clinical trials, which might help to decrease the risk of HIV acquisition and/or control partially the inflammation of PLWH.