Angela Wahl

This plenary session chaired by Linda-Gail Bekker (Desmond Tutu HIV Foundation) and Agustín López González (Ministry of Health, Mexico) focused on the treatment of HIV-associated co-morbidities to improve the health of people living with HIV, optimal financing of HIV programs, and the benefits of treatment during primary HIV infection.

Esteban Martínez highlighted data demonstrating the increased prevalence (incidence and number per person) of comorbidities in people living with HIV (PLWH). Age and smoking are major risk factors for comorbidities in PLWH. ARV-associated comorbidities are better managed by treating the comorbidity rather than switching the ARV. Sherrie Kelly advocated for governments to make evidence-based spending choices and to say no to less cost-effective HIV interventions in order to save more lives and prevent more infections. Overall, increasing ART coverage and targeting key populations is more cost-effective than more general community-based HIV prevention programs. John Frater discussed the benefits of starting ART during primary HIV infection which included quicker immunologic recovery, reduced HIV transmission, and the opportunity for new therapeutics. ART treatment during primary infection can restore CD4 levels, normalize the CD4:CD8 ratio, reduce inflammation and results in a smaller reservoir size which may aid the effectiveness of cure strategies.

Comorbidities will become more prevalent as the population of PLWH ages. Therefore, it will be important to promote a healthy lifestyle now in PLWH and screen PLWH for comorbidities early so that they can be effectively managed with approved interventions. The number of new HIV infections and HIV-associated deaths could be reduced by restructuring government spending and increasing the uptake of ART during primary HIV infection.