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IDWeek and HIV Glasgow 2024
Perspectives From Australia: Key Studies From IDWeek and HIV Glasgow 2024

Released: December 16, 2024

Expiration: December 15, 2025

Sharon R. Lewin
Sharon R. Lewin, AO, FRACP, PhD, FAHMS
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Key Takeaways
  • Studies presented at both IDWeek 2024 and HIV Drug Therapy Glasgow 2024 emphasize the importance of monitoring for immune-related adverse events in people living with HIV receiving immune checkpoint inhibitors for cancer treatment.
  • With the resurgence of mpox, people living with HIV may be more vulnerable to severe outcomes, underscoring the need for vaccination and early intervention in high-risk populations such as men who have sex with men.

Although the topic of long-acting antiretrovirals (ARTs) continues to dominate presentations on HIV treatment and prevention, many other important studies were presented at IDWeek 2024 and HIV Drug Therapy Glasgow 2024 (HIV Glasgow 2024) that are relevant to Australian healthcare professionals.

Immune Checkpoint Inhibitors for Cancer in People Living With HIV
An excellent session at HIV Glasgow 2024 on comorbidities and coinfections featured a prospective study involving people living with HIV who received immune checkpoint inhibitors as part of cancer treatment called ANRS-CO24-OncoVIHAC. This study is significant given the high prevalence of cancer among people living with HIV and the growing use of immune checkpoint inhibitors for treating cancers such as melanoma and lung cancer. In addition, anti–PD-1 therapy is increasingly being explored as a potential component of HIV cure strategies, including in Australia

ANRS-CO24-OncoVIHAC is a prospective observational cohort study in France that focuses on people living with HIV who also have cancer and are being treated with immune checkpoint inhibitors. The study found that the incidence of a first episode of grade ≥3 immune-related adverse events (irAEs) was 15.0% (95% CI: 9.6%-22.9%) at 1 year. The cumulative incidence of all severe irAE episodes was 26.9 per 100 person-years. Factors associated with the occurrence of severe irAEs included low CD4+ cell count, positive cytomegalovirus serology, a history of cancer surgery, and a longer time since HIV diagnosis.

ART Adverse Events
Adverse events associated with current ART regimens continue to pose challenges in clinical care. At HIV Glasgow 2024, this was the focus of the data presented from the GESIDA 11920-Mind study, a randomized, multicenter, double-blind clinical trial. The study evaluated the safety and convenience of switching from dolutegravir (DTG)/lamivudine (3TC) to bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in people living with HIV who had good virologic control and neuropsychiatric comorbidities.

At Week 24, switching from DTG/3TC to BIC/FTC/TAF did not result in short-term neuropsychiatric safety benefits. However, improvements in gastrointestinal tolerability and lipid profiles could make the switch beneficial for those experiencing gastrointestinal intolerance and/or dyslipidemia.

Mpox
One coinfection of growing concern in people living with HIV is mpox, caused by the monkeypox virus (MPV), with a resurgence of cases observed during the past 12 months in many countries, including Australia. Abstracts detailing MPV infection in people living with HIV were presented from France, Hong Kong, Taiwan, Italy, and Austria.

At HIV Glasgow 2024, clinical and demographic data were presented from a study in France on polymerase chain reaction–confirmed cases of MPV. Between August 2023 and June 2024, 31 laboratory-confirmed cases of clade IIb MPV infections were reported, indicating persistent transmission of this strain in France. This continued spread was attributed to asymptomatic carriers and inadequate vaccination coverage among high-risk individuals, such as men who have sex with men. People living with HIV accounted for one third of the MPV cases, including 9% in whom MPV revealed undiagnosed HIV infection, highlighting the importance of targeted prevention efforts and vaccination for men who have sex with men.

In a smaller, single-site study from Austria, also presented at HIV Glasgow 2024, 21 individuals with previous MPV infection were followed for 15 months. The authors found that 43% (9/21) of participants showed scarring at least at one site of previous MPV lesions.

MPV data were also presented at IDWeek 2024, including a large retrospective study using de-identified data from healthcare systems in New York City, which included more than 50 tecovirimat prescriptions. The study focused on people with probable or confirmed MPV infection who initiated tecovirimat treatment between May and December 2022. Clinical outcomes were presented for 708 participants, of whom 56% were people living with HIV.

The most common long-term sequela was scarring (n = 69; 10%). Among the 100 (14%) hospitalized patients, the reasons for hospitalization included pain (25%), bacterial superinfection (22%), and dysphagia (13%). The median delay from symptom onset to treatment initiation was 8 days (interquartile range: 6-11), with a longer delay observed for Black patients.

This study is one of the largest examining tecovirimat use. Although it was not designed to determine efficacy, the additional information on safety and adverse events will be of significant interest to healthcare professionals, particularly given the ongoing circulation of MPV in Australia and other regions.

Your Thoughts?
How will these key studies from IDWeek 2024 and HIV Glasgow 2024 affect your practice? Get involved by posting a comment below!