Conference Proceedings From the 26th Bangkok International Symposium on HIV Medicine

Abstract

The first Bangkok International Symposium on HIV Medicine was launched in January 1998 with the aim to provide up-to-date information on HIV to professional heathcare workers in Thailand and surrounding countries who cannot afford to attend conferences abroad. After several virtual conferences during the COVID-19 pandemic, this is the second face-to-face meeting held in Bangkok from 17 to 19 January 2024. There were a total of six plenary sessions each morning and two afternoon workshops on Wednesday and Thursday. The symposium had expert speakers from Thailand, Australia, Taiwan, India, Malaysia, the UK, the USA, Japan, Singapore, the Philippines and Vietnam.

Keywords: :

• adolescents
• antiretroviral therapy
• ART
• co-infections
• comorbidities
• COVID-19
• health-related quality of life
• HRQOL
• people living with HIV
• PLWH
• pre-exposure prophylaxis
• PrEP
• prevention
• transgender health

Day 1, session 1: COVID-19 & other epidemic diseases

Kiat Ruxrungtham (Chulalongkorn University, Thailand) discussed the role of mRNA vaccine development for pandemic preparedness and beyond. After successfully developing an mRNA vaccine against COVID-19 in collaboration with the University of Pennsylvania [1], the Chulalongkorn Vaccine Research Center is focusing on the development of mRNA vaccines for other infectious diseases including Dengue, HPV, leptospirosis, Avian influenza, Plasmodium vivax and Nipah virus. Regional collaborations to improve vaccine equity and pandemic preparedness are important.

Anthony Kelleher (The Kirby Institute, University of New South Wales, Australia) provided insights into the pathophysiology of prolonged and varied symptoms following acute SARS-CoV-2 infection that have been termed long COVID. He illustrated the immunopathologic and clinical findings from the ADAPT study. After 8 months, long COVID has a diffuse immunological footprint with increased type I and III interferons, increased activation of monocytes, depletion of certain naive CD4⁺/CD8⁺ T cell and B cell subsets and increased PD-1+/Tim-3+ CD8⁺ memory T cells. These findings are consistent with ongoing activation of the innate immune system and potential antigen and bystander T-cell activation.

Opass Putcharoen (Chulalongkorn University, Thailand) gave an overview of the diagnosis and treatment of Mpox in people living with HIV (PLWH). He discussed the use of the Jynneos^® vaccine for pre- and post-exposure prophylaxis (PEP) [2], and the use of Tecovirimat or vaccinia immune globulin intravenous as alternatives for PEP [3,4].

Session 2: prevention

Eamonn Murphy (UNAIDS Asia–Pacific Region, and Eastern Europe and Central Asia Region) talked about universal HIV prevention in the Asia–Pacific region. He discussed how marked inequalities within and between countries are stalling progress in the HIV response; in the last 12 years, the decline of new HIV infections has stalled. In many countries, there are increasing numbers of men who have sex with men, and non-key population women are contributing high numbers of new HIV infections. Overall, HIV is concentrated among key populations and their partners. Legal barriers affect HIV response in 39 UN member states in the Asia–Pacific [5]. Pre-exposure prophylaxis (PrEP) uptake in Asia is too slow to affect the course of the epidemic; needle-syringe and opioid substitution coverage is low in many countries; up to 50% of key populations remain unaware of their HIV status; and antiretroviral therapy (ART) coverage falls below the 95% target, sometimes dramatically, in almost all Asia–Pacific countries. Intensifying the focus on key populations in policies and programs, modernizing HIV service delivery and eliminating barriers to equitable program coverage including law reform are vital to ending inequalities and ending AIDS.

Stephane Wen-Wei Ku (Infectious Diseases, Taipei City Hospital Renai Branch, Taiwan) talked about “Chemsex in Asia–Pacific region: Where are we now and where are we going?”. He reviewed the prevalence and types of drugs used in different countries. Methamphetamine was the default substance associated with Chemsex among MSM in Asia [6]. Treatment options for dependence include cognitive behavioral therapy, pharmacological interventions [6,7], harm reduction strategies, education and communication, needle and syringe programs, Voluntary counselling and testing (VCT) for sexually transmitted infections (STIs) and HIV, suppressive ART, PEP and PrEP [8].

Praphan Phanuphak (Institute of HIV Research and Innovation, and HIV-NAT, Thailand) gave the Lange Memorial Plenary on “The role of doctor activists in improving patient health outcomes”. He paid a tribute to the late professor Lange and his contributions to the field of HIV, and reflected on his own distinguished career in Thailand, advocating for the rights of PLWH. He discussed that a doctor activist’s role is to speak out loudly to the public about the unjustified conditions faced by patients, fight for the availability of life-saving treatments, fight against unjustified laws, stigma and injustice. He stressed the importance of undertaking pilot projects that could be used as proof of concept for policy makers and thinking outside the box to impact National Policy.

Day 2, session 1: comorbidities

Andrew Hill (Liverpool University, England) gave the Cooper Memorial Lecture on “Long-term safety of integrase inhibitors”. He paid tribute to the late Dr Cooper and his legacy of work. WHO first-line treatment guidelines now include dolutegravir as a preferred regimen, and Dr Hill reviewed current evidence relating to safety. Despite initial concerns, there is no increased risk of immune reconstitution syndrome or neural tube defects with integrase strand transfer inhibitor (INSTI). Mild insomnia can occur, as can weight gain, which is most severe for black women and people who initiate INSTI with low CD4 counts and advanced HIV disease.

Markella Zanni (Harvard Medical School and Massachusetts General Hospital, USA) talked about “Cardiovascular risk management in PLWH: Results from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE)”. Now that PLWH are living longer, there is an increased risk for atherosclerotic cardiovascular disease (ASCVD). This is partly due to traditional risk factors and persistent systemic immune activation. The REPRIEVE study showed that pitavastatin therapy reduced major adverse cardiovascular events by 35% among PLWH with low-to-moderate ASCVD risk [9]. The British HIV Association (BHIVA) recently recommended the use of statins for primary prevention of cardiovascular disease (CVD) in PLWH aged ≥40 years regardless of lipid profile or with an estimated 10-year CVD risk of 5% or greater [10].

Junko Tanuma (National Center for Global Health and Medicine, Japan) talked about cancers in PLWH, who are at risk from virally mediated and nonvirally mediated cancers. These may increase in an aging population and are associated with the degree of immunosuppression [11]. PLWH should be included in national population screening programs and receive the same standard, full-dose regimens recommended for the general population. Efforts are needed to improve inclusion of PLWH in cancer clinical trials in resource-limited settings.

Session 2: debate: Doxy PEP should be standard of care of PLWH & PrEP users

The pro team was Donn Colby (US Military HIV Research Program, USA) and Rossaphorn Kittiyaowamarn (Bureau of AIDS, TB and STI Department of Disease Control, Thailand). The con team was Wong Chen Seong (Tan Tock Seng Hospital, Singapore) and Cao Thi Thanh Thy (Hanoi Medical University Hospital, Vietnam). Both teams presented eloquent arguments for and against the proposal, which raised awareness about important issues, and was a highlight of the conference.

Day 3, session 1: beyond viral suppression

Thuy Le (Duke School of Medicine, USA/Tropical Medicine Research Center for Talaromycosis, Vietnam) talked about “Invasive fungal infections in PLWH”. In Asia, PLWH continue to present with low CD4 counts and fungal opportunistic infections remain a leading cause of AIDS-related death. For talaromycosis, antigen immunoassays provide a more rapid turnaround time and more sensitivity and specificity compared with blood culture. New guidelines developed by WHO recommend a single high dose of liposomal amphotericin B for the treatment of cryptococcal meningitis in PLWH. This recommendation was made following the results of the AMBITION trial [12].

Nicholas Paton (National University of Singapore, Singapore) talked about “approaches to shortening treatment for drug sensitive TB”. There are three approaches to shorten treatment for TB: use new drug regimens with improved activity against dormant/persistent bacteria (sterilizing activity), improve the immune response to clear persistent bacteria and use innovative treatment strategies. TRUNCATE-TB study showed that a strategy involving initial treatment with an 8-week bedaquiline–linezolid regimen was noninferior to standard treatment for tuberculosis with respect to clinical outcomes. The strategy was associated with a shorter total duration of treatment and with no evident safety concerns.

Raja Iskandar Shah Raja Azwa (University of Malaya, Malaysia) talked about the “Progress toward the 4th 90”. WHO has recommended a more holistic, people-centered HIV care approach focused on long-term well-being which includes focusing on health-related quality of life (HRQOL), management of multimorbidity (i.e., noncommunicable diseases, mental health) and reducing stigma and discrimination [13].

Session 2: key populations & 2023 research update

Thanyawee Puthanakit (Chulalongkorn University) talked about “Adolescent Health and Well-Being: Co-Creating an AIDS-Free Generation”. Adolescence is a period of life with specific health and developmental needs and rights [14]. She described the importance of youth friendly and youth-led health services, such as the Buddy CU Clinic at Chulalongkorn Hospital. Online platforms are an important mechanism for reaching and caring for youths. Such people-centered integrated approaches can help to optimize health outcomes for adolescents.

Jan Dio Miguel Dela Cruz (Victoria by LoveYourself and Philippine Professional Association for Transgender Health [PPATH], Philippines) talked about ”Transgender Health: the path to gender affirmative care”. He shared his experience in providing gender affirmative care in transgender health to ensure a safe and secure space for clients to receive inclusive, self-determined and rights-based care.

Nagalingeswaran Kumarasamy (VHS Infectious Diseases Medical Centre, India) talked about the “Top 5 HIV developments of 2023 that will change your practice”: ART for first line failure (D2EFT study) and noncommunicable diseases (NCD), the use of dual therapy among PLWH with suppressed viral load (SOLAR-3D), the use of long-acting HIV regimens (Safety Net Clinic Population, inJectable Antiretroviral feasiBility Study (JABS) and Lenacapavir), ARV regimen in pregnant women (IMPAACT trial), and ARV and broad neutralizing antibodies strategies.

There were four workshops: adolescent health, opportunistic infection, aging/comorbidities and laboratory.

The next symposium, the 27th Bangkok International Symposium on HIV Medicine, will be held from 15 to 17 January 2025.

Conference details

26th Bangkok International Symposium on HIV Medicine from 17 to 19 January 2024 at Samyan Mitrtown Hall (Bangkok, Thailand).

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Competing interests disclosure

The 26th Bangkok International Symposium on HIV Medicine was supported by ViiV GSK, amfAR/TREAT Asia, Atlanta (Mylan), Gilead and DCH Auriga, Camber Pharmaceuticals, Inc., Government Pharmaceutical Organization (GPO), Abbott Laboratories Ltd., Biomedia (Thailand) Co., Ltd, and the Kirby Institute. SJ Kerr is affiliated with the Kirby Institute. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Acknowledgments

The authors thank all of the speakers for providing the latest information on HIV to the symposium, the chairpersons for coordinating with the speakers for the workshop and the scientific committee for their advice in developing the program. The authors also thank the Bangkok Symposium Team, especially Kesdao Nanthapisal, Chavalun Ruengpanyathip and Engon Phuengchangam.