James McMahon

This session focussed specifically on ageing and HIV and a specific presentation on diabetes. A more global look at all non-communicable diseases and HIV was also included with suggestions on best interventions to minimise NCDs.

HIV and diabetes go hand-in-hand globally, with key features being the importance of screening all PLHIV for diabetes and how HbA1c measurements underestimate glycemia in HIV. We need to monitor if increased INSTI use leads to increased diabetes incidence with emerging data around weight gain. Next, we learnt how PLHIV accumulate “age-related” diseases at a younger age and that these conditions account most deaths in PLHIV. Also, that ART-treated people have chronic immune activation superimposed upon immunologic senescence and less robust immunologic response to ART in older adults. Ultimately, we need to educate providers on management of comorbidities: their manifestations, drug interactions, and the interplay between ART, diseases and the host. Andrew Carr gave an excellent overview of NCDs and HIV including summaries on weight gain with INSTIs, key takeaways are to focus on WHO ‘best-buy’ interventions: decreasing tobacco use and harmful alcohol use, increasing healthy diet and exercise.

This section was an excellent overview of NCDs in PLHIV and brought together data from this conference and across the spectrum of NCDs. Being aware of the ageing HIV population and the importance of aggressive management of NCDs as PLHIV age was a consistent them in the session. Understanding the key interventions to best manage a range of NCDs was an important takeaway: minimise tobacco use and harmful alcohol use, improve diet by minimising fat and salt intake and increase exercise.