Our final update to our coverage of the 2015 IAS Conference!

The Moving Epidemic: Demographics and Migration

Speakers: J Brophy, Joel Singer, Julie Pannetier, Roxanne Kerani, M Grabowski

Organizations Represented: University of Ottawa, UBC, IRD, University of Washington, John Hopkins Bloomberg School of Public Health

This seminar guided the conversation about migration and HIV transmission. For example women who travel from countries such as Haiti at one point had a high vertical transmission rate when arriving in Canada. However, the current vertical transmission rate for foreign born mothers in only 10.5%, the former can be attributed to better access of care and target campaigns for immigrants. Also, researchers looked at the high HIV rate in France and migration. A new study by Pannetier found that most immigrants (particularly Sub-Saharan African immigrants) who acquired HIV, did so when they immigrated to France.

Key Points

  • Objective is to describe geographic origin trends of HIV positive mother infant pairs in Canada, regional variation of foreign born mothers (most common countries across Canada of origin are Haiti, Ethiopia and Congo)
  • Shows flow of immigration of refuges from political unrest countries.
  • 84% to 10% improved FBM diagnosed with HIV during pregnancy (improved testing and ART therapy).
  • Canadian HIV perinatal Surveillance Program, restricted to infants born in Canada to mothers who are positive, objective is to describe the uptake and therapy over time, increase number of mother-infant pairs (better treatment means women are able to have children).
  • As treatment gets better vertical transmission rates decrease, only one child in the past year in Canada, Uptake of optimal therapy in progeny has steadily increase, vertical transmission rare, keep groups that were being untreated are now getting resources.
  • HIV 49% of acquisition in France when subsaharan migrants, higher than the Uk, need to improve HIV prevention in Sub-saharan migrants.
  • Large variation in HIV prevalence and risk factors in Rakai (Africa), need for a granular approach to HIV prevention and response on local assessment and tailored interventions. ( can’t distinguish women who are commercial sex trade workers, because in it criminalized).

Prospective Questions

  • Do migrant populations engage in particular at risk behaviour (ie IDU, or unprotected sex) that leaves them more susceptible?

Towards an HIV Cure

Speakers: Sharon Lewin, Mark Gilbert, Matthew Sharp, Rene Masching, Tharao Wangari, Andrew Lambert, Robert Reinahard, Nicolas Chomont, Judith Auberbach, Bruno Spire

Organizations Represented: CANFAR, IAS, CIHR, CanCure, Catie, OHTN

The overall topic of interest for the seminar was the concept of marginalization and HIV transmission. Researchers have notices that marginalization of populations can lead to higher rates of HIV exposure. Also, a concern that was presented was creating a more unified network of voices that can broker new policies with governments. The same former concept can be applied to the messaging for marginalized populations: keep the message simple.

Key Points

  • Collaboration between government , academic researchers and community must continue to dialogue and be sensitive to the chaining needs of each community.
  • Engage and generate advocacy for cure research with specific population and different approaches to complex individual health concerns and determinants.

Prospective Questions

  • Does gender or biological sex matter in cure studies?

Characterizing the Latent Reservoir

Speakers: Eli Bortiz, Gustavo Kijak, Nicholas Chomont, Angela Cluffi, Jacob Estes

It seems that more research needs to be done to find out what role latent reservoirs play in replenishing or even mutating a drug resistant virus back into the body. The latent reservoir material is extremely long lived.

Key Points

  • Major challenges remain with our knowledge of latent reservoirs.
  • Trying to genetically characterize latent viral genomes.
  • Lymph node cells latent reservoirs maintains virus replication.
  • It appears that the viral reservoirs are seeded very early during active infection.
  • It also apprise that the reservoirs contain an archive of viral information.

Prospective Questions

  • Do the lymphatic nodes store a latent HIV reservoir and release into the body? or are they they effective pool of HIV material?

Children and Adolescents living with HIV discovery and Management

Speakers: Tsitsi Bandason, Anjuli Wagner, Elanor Magongo, Emma Connetta Manno

Organizations Represented: University of Washington, Biomedical Research and Training Institute, Ministry of Health Uganda,
Bambino Gesu Children’s Hospital, Fred Hutchinson Cancer Research Centre

A majority of children are still being untested due to location, lack of clinical care or stigma in the community. Education and training approaches to nurses and midwives are changing the amount of children being tested and brought in for primary care.

Key Points

  • Home testing for older children increased in HIV Diagnosis. Parents were either unable or reluctant to take children to centralized care clinics.
  • Only high risk children were seen to be brought in to a clinic.
  • Many people were from rural settings and were unable to take time from work or lacked transportation to test children.
  • Algorithms developed to test children captured an approximate 80% of previously undiagnosed children.
  • Test and treat approach included a guaranteed time frame of supplying HIV medication to the children found to be HIV positive.

Prospective Questions

  • It seems that home testing is increasing testing, but the questions still remains getting the ARV’s to a majority of people in rural community settings.

Towards an HIV cure

Speakers: Sharon Lewin, Mark Gilbert, Matthew Sharp, Renee Masching, Tharao Qangari, Andrew Lambert, Robert Reinhard, Nicolas Chomont, Judith Auerbach, Bruno Spire

Organizations Represented: CANFAR, IAS, CIHR, CanCure, Cattie, OTHN

Experiences of marginalization can Lead to a higher rate of HIV exposure. Networking to share a unified voice to be heard by governments and policy Makers needs to strengthen to make any noticeable changes. There is a need to keep the message simple to marginalized populations.

Key Points

  • Collaboration between government, academic researchers and community must continue to dialogue and be sensitive to the changing needs of each community.
  • Engage and generate advocacy for cure research with specific populations and different approaches to complex individual health conditions and determinants.

Prospective Questions

  • Does gender or biological sex really matter when searching for the HIV cure?
  • Chronic or Co infections on immune exhaustion/dysfunction need to be taken Into consideration when researching a cure.

Preventing HIV and Hep C among people who inject drugs: Challenges and Opportunities.

Speakers: Tetiana Deshko, Eliot Ross, Albers, M-J Maloy, Lisa Maher

Challenges and barriers still exist for harm reduction programs for PWID with lessons learned from the North American experience with HIV TasP. The role of drug treatment and opioid substitutions therapy comes down to the will of the Governments and political will.

Key Points

  • There is a need for continued and massive advocacy support to apply harm reduction methods to start making a difference in the PWID community.
  • PWID are still some of the most marginalized communities due to the lack of medication compliance and the fear of HIV medication resistant strains spreading to the mainstream population.
  • More access to clean equipment will help reduce the spread of Hep C.
  • Stigma, costs of treatment, criminalization and lack of public health support continue to fuel this epidemic.

Prospective Questions

  • How can we normalize or humanize PWID’s and get them more effectively into care.

Co Morbidity and ageing in HIV: a global challenge.

Speakers: Matthew Freiberg, Ken Kunisaki,

Panel Discussion: Mikaela Smit, Wafaa el-Sadr, Meg Doherty

it appears that the high prevalence rate of smoking in the HIV community seems to indicate the lack of mental health support. People appear to be self medicating with cigarettes due to the poor accessibility rate to health care.

Key Points

  • Cardiovascular and pulmonary complications in patients with HIV as they age increase the need for an integrated health care approach.
  • Management of multi morbidities with these patients will need a multi care approach that is just not ready to meet an aging HIV population.
  • Mental health support is missing when addressing HIV, depression, isolation, aging and suicide.

Prospective Questions

  • More study in HIV and ageing is needed. We need to consult with the population to ask them what they want and need.

Hepatitis B in HIV: The Forgotten Virus?

Speakers: Jennifer Jao, Chien-Ching Hung, Sanjay Bhagani, Odile Launay

As we move towards the target goal of 90-90-90 by the year 2020, we must consider HIV coinfection with Hep B & Hep C. Countries such as China and India still have very high rates of coinfection. New World Health Organization (WHO) guidelines for Hep B & Hep C are a step in the right direction. All HIV patients should be screened for HBV markers. In the case where tenofovir causes renal damage, entecavir may be used in it’s place with acombination ART.

Key Points

  • HBV is usually easy to clear in adulthood through treatment; most is acquired in perinatal and preschool ages.
  • Studies conducted in Taiwan revealed that chronic Hepatitis B (HBV) infection in HIV positive individuals led to an increased risk of hepatic flares, hepatic death and overall mortality.
  • Because these two viruses share the same transmission route, rates of HBV are higher in HIV-infected populations.
  • Health care professionals must weigh risks and benefits when considering timing of HBV vaccination and may improve vaccine efficacy and response rate by the inclusion of adjuvants.
  • Vaccination for HBV should be done when when HIV RNA is undetectable.

Prospective Questions

  • In Canada, there is a lack of information concerning the prevalence of HIV/Hep-B coninfection. How can we draw attention to the importance of coinfection in Hiv positive individuals?

Relevant Web Links

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