Yusuf Hassan Wada

The symposium introduce metabolic consequences including weight gain of key and vulnerable populations of new classes of ART. Presentations were centered around metabolic consequences linked to menopause, hormones and trans populations and older people which bring to light some of the latest scientific evidence impacting them on ART.

Dr. Jacqueline CAPEAU provided an insight to weight gain among PLWH. She discussed how initiation with an INSTI, mainly DTG and BIC, were associated with larger weight gains than with other agents especially in those who initiated treatment late. She showed that weight gain was related to age, genetic factors, sex, hormonal status, food intake, exercise (or lack of) as well as adipose tissue dysfunction and inflammation. Presentation on how hormone therapy (HRT) increases body weight in transgender people more pronounced among trans women regardless of the ART regimen was done by Dr. Emilia JALIL. She commented on the potential drug-drug interactions between ART and HRT and the impact on efficacy and side effects. Dr. Tristan BARBER similarly highlighted the extent in which the proportion of people PLWH who are age 50 and older has increased dramatically especially in LMICs. Dr. Isabel CASSETTI highlighted on how women living with HIV (WLHIV) have higher levels of inflammation than men probably due to the increase of TLR7 expression while postmenopausal WLHIV who are at a greater risk of bone loss (more pronounced when using TDF plus PI), had evidence of increased innate immune activation related to premenopausal women.

The intersection between PLWH and metabolic consequences of new classes of ART highlights a significant multi-morbidity these individuals face. Thus far, people over 50, menopausal women and transgender people have been poorly represented in randomized and observational clinical studies which may refrain health providers from providing adequate care. Therefore, there is a need for more research and a patient centered care such as counselling, and recording information’s accurately such as adverse events and finally promoting behavioral change on metabolic risk factors.