For the first time since BC-CfE Executive Director & Physician-in-Chief Dr. Julio Montaner welcomed the world to Vancouver in 2015, the International AIDS Society returned to Canada July 29th, bringing the 24th International AIDS Conference to Montreal (AIDS 2022). The world’s foremost meeting on HIV research, advocacy and policy-making, the biannual conference is the largest global gathering on any health issue in the world.
Hosting the conference in Montreal, offered the Canadian government an opportunity to highlight their support of HIV/AIDS at home and abroad. Notably, the federal Minister of Health Hon. Jean-Yves Duclos began the week formally endorsing the Global Declaration on Undetectable=Untransmittable (U=U). The campaign of U=U was a central theme throughout the conference and is built on the science of Treatment as Prevention¨, empowering people living with HIV with the knowledge that they can’t transmit HIV when they are on effective treatment with an undetectable viral load.
Canada announced an $18 million investment in HIV testing accessibility (particularly in northern, remote and isolated communities) and a $15 million commitment to the UNAIDS for the global response through 2025. Ahead of the conference, Attorney General of Canada David Lametti met with community partners and announced the launch of consultations to modernize the criminal justice system’s response to HIV non-disclosure which will begin in October 2022.
While these commitments were well-received on a national level, they were sadly overshadowed among the global delegates, as many international attendees were unable to secure visas to enter Canada despite months of urgent calls to expedite them. As the HIV community strives to bridge the disparity in treatment and care between developed and developing nations, the absence of voices from predominantly developing nations due to delayed or denied visas was felt throughout the conference; culminating in a panel discussion in which all six chairs sat empty due to the panellists being denied entry.
The conference opened with a stirring presentation from Indigenous leaders including BC-CfE Indigenous Peer Research Associate Claudette Cardinal who attended the conference to share her experiences as a representative at the Canada Pavilion. What followed was five full days of activist-led calls to action, policy discussion and research presentations, in which the BC-CfE was well-represented among the accepted abstracts.
Poster presentations from the Epidemiology and Population Health program explored antiretroviral (ARV) treatment safety and quality of life factors experienced by people living with HIV (PLWH). Research Assistant Olivia Hunt’s work on adverse drug reactions associated with generic-equivalent ARVs found low incidence of adverse drug reactions attributed to generic product substitution. Presenting SHAPE (STOP HIV/AIDS¨ Program Evaluation) Study data, Study Coordinator Clara Tam provided a look at factors associated with ARV treatment interruption. Revealing socio-structural marginalization including incarceration, violence and homelessness increased treatment interruption, the findings illustrate the need for re-engagement programs to address structural factors impacting treatment.
Acknowledging the increased prevalence of violence experienced by PLWH, Research Assistant Kalysha Closson presented COAST (Comparative Outcomes And Service Utilization Trends) Study data looked at healthcare utilization and mortality related to experiences of violence. Findings revealed higher violence/abuse-related healthcare utilization among PLWH compared to people not living with HIV, and illustrated the need to integrate violence prevention and support services within HIV care. Also presenting COAST Study data, PhD Student Ni Gusti Aye Nanditha, used disability-adjusted life years (DALY) to describe the burden of comorbidities among PLWH. The analysis found PLWH experienced a twofold higher DALYs associated with chronic comorbidities (predominantly cancers and cardiovascular disease).
Turning to pre-exposure prophylaxis (PrEP), Drs. Jordan Sang and Viviane Lima delivered updates from BC’s PrEP program. Dr. Sang presented on the secondary impacts of COVID-19 on PrEP use among gay, bisexual and men who have sex with men (gbMSM) in Vancouver, finding increased PrEP interruptions and trends of depressive symptoms during the pandemic. These findings as part of the Engage Study encouragingly discovered decreasing trends of polysubstance use, interpersonal violence and binge drinking, but on the whole, illustrated the need for additional mental health services and targeted follow-up for those on PrEP. Dr. Lima evaluated the impact of increased syphilis testing through the HIV-PrEP program, finding a significant decline in syphilis incidence among gbMSM as a result.
The BC-CfE Laboratory assumed additional COVID-19 research and testing over the past two years and looking at how COVID-19 impacts PLWH, presenting on this research to AIDS 2022 also. Research Assistant Aniqa Shahid’s study on HIV genetic diversity between blood and lung tissue while on ART, examined whether there would be marked differences between the two. Findings indicated a strong correlation between the two suggesting that blood is likely a strong indicator of genetic diversity elsewhere in the body. Laboratory Research Coordinator, Hope Lapointe was awarded a full scholarship to attend the conference and presented his poster on COVID-19 vaccine-induced immunity among people living with HIV in Montreal. As has been reported earlier, this work illustrated that PLWH on suppressive ARV treatment (ART) mount strong humoral responses after two and three-dose COVID-19 vaccination.
Laboratory Director, Dr. Zabrina Brumme attended in person to deliver a highly informative oral presentation on HIV reservoir dynamics and its implications on HIV cure research. Presenting a technical and in-depth look at reservoir establishment and persistence, Dr. Brumme demonstrated how we can infer pre-ART reservoir dynamics and decay rates of proviruses from the ages of the existing proviruses sampled shortly after ART-mediated suppression. While providing novel insights into the current state of HIV cure research, this work also reinforces how critical early ART is to limit reservoir size and genetic diversity.
Finally, Data Analyst, Jason Chia was the recipient of the Bonnie Devlin Memorial Bursary and attended the conference virtually. Established in 2017, the bursary honours former Research Coordinator Bonnie Devlin, who worked with the BC-CfE for 15 years before passing away in 2008 after a courageous battle with cancer. The bursary supports a member from the Epidemiology and Population Health department to attend the conference to broaden their knowledge and skills.
Reflecting on the conference, Jason was particularly struck by the emerging science on long-acting ARVs and topics surrounding global policy development for equity of access to HIV treatment and healthcare.
I would like to express my gratitude for the opportunity to attend AIDS 2022. I learned a lot from speakers worldwide, including PLWH, researchers, and many others.
– Jason Chia, Data Analyst