Saskia Janssen

Management of co-infections in people living with HIV (PLHIV) remains a challenge. This symposium summarized new evidence in tuberculosis (TB) impacting on treatment and prevention guidelines, the biomedical impact of COVID-19 on PLHIV, and management of viral hepatitis (HBV).

Despite major efforts, one third of people with active TB remains undiagnosed. Prof Meintjes highlighted new tools supporting recent guidelines to expand the target population for TB screening. Addition of elevated CRP or chest X-ray to symptom screen in PLHIV is beneficial to TB detection. WHO now recommends early initiation of ART in all HIV-infected, regardless of CD4-count. Shortening of TB treatment is becoming reality with approved 4-month regimens for drug sensitive TB and BPaL(M) regimens shortening treatment for drug-resistant TB to 6 months. Dr. Berenguer gave an overview of current guidelines for the management of HIV/HBV co-infection. New developments include the antiviral bulevirtide for hepatitis delta and development of Hepislav-B, a HBV vaccine requiring only 2 doses in PLHIV. Fibrosis scores APRI and FIB-4 turn out unreliable for surveillance of fibrosis in HIV/HBV co-infected patients. Controversy remains at the intertwine of COVID-19 and HIV. Dr Kumarasamy highlighted that whilst the risk of infection appears unchanged, differences occur in progression to severe disease in advanced immunosuppression, comorbidities and ageing. COVID-19 can impact on PLHIV in the longer term with worsening of comorbidities, development of TB and mucormycosis. Vaccine responses appear to be weakened in PLHIV, requiring additional boosters.

New tools can impact significantly in closing the gap of undiagnosed TB by systematic screening of PLHIV regardless of symptoms. Recent evidence is shifting the paradigm towards shortened regimens for drug-sensitive and resistant TB. Patients with severe HIV-TB and TB meningitis require special attention; research is underway to improve their management. Regarding HBV, long-term data is needed to assess superiority of TAF versus TDF as presented earlier at this conference. Continuation of ART without disruption is crucial to prevent immunosuppression, exposing PLHIV to increased risk of severe COVID-19, and contributing to occurrence of new variants of COVID-19.