Recap: 17th Ryan White HIV/AIDS Program Clinical Care Conference

Highlights from Laura W. Cheever, MD, ScM, HRSA HIV/AIDS Bureau Associate Administrator and Conference Co-Chair

 The field of HIV/AIDS care and treatment continues to evolve rapidly. Groundbreaking developments in HIV research are regularly presented at international meetings and in journal articles. Headlines follow, and care providers in thousands of clinics and offices around the world figure out what this new knowledge means for their practice and their patients. The annual Ryan White HIV/AIDS Program Clinical Care Conference serves as a venue where these providers can discuss these developments with their peers and expert clinicians. 

It’s a great balance between state-of-the-art treatment and science and pragmatic things that Ryan White HIV/AIDS Program providers struggle with and need assistance with,” said Dr. Laura Cheever, Associate Administrator of the HRSA HIV/AIDS Bureau, which oversees the federal Ryan White HIV/AIDS Program (RWHAP). Cheever said this learning format is particularly helpful to grant recipients such as RWHAP Part C clinics, in order to “meet the educational needs of these expert clinicians.”

“We are coming to a new era of ARVs [antiretrovirals] that will probably change our patterns of prescribing. One advancement under study is long acting agents, including two by injection. They may be coming soon, in the next few years, for both treatment and PrEP.”  Dr. Laura Cheever

The 17th RWHAP Clinical Conference was held in San Antonio on August 21-23. In addition to the more than 300 attendees, clinicians across the country could participate via live stream or access online archives for web viewing. We touched base with Dr. Cheever, one of the co-chairs of the conference, to get some highlights. 

National HIV Curriculum | Antiretroviral TherapyOpportunistic InfectionsOpioid EpidemicGeriatricsTuberculosis (TB) 

National HIV Curriculum

 The Clinical Care Conference “always has a series of workshops to give people one-on-one time with experts,” Cheever said. In the mix this year were two such workshops that focused on the new National HIV Curriculum from the RWHAP AIDS Education and Training Centers (AETC). The online National HIV Curriculum was developed in collaboration with HRSA and the AETC National Coordinating Resource Center (NCRC), with David Spach, MD, from the University of Washington as the lead editor. AETC faculty members from around the country participated as authors and reviewers.

Cheever said the curriculum has a diverse audience, including residency, pharmacy, and nursing programs, to train the next generation of HIV care providers. “It covers the range of HIV, from testing to initial assessment to ARVs, to opportunistic infections," said Cheever, who added, “It’s going to be a very useful resource to training new HIV practitioners in the field. Clinics and training institutes can track who has taken specific trainings and acquired specific competencies [online]” so that programs can assess whether they have sufficient knowledge.

The Curriculum has features for clinicians ranging from novices to experts in the field of HIV care. In addition to the core training modules, the Question Bank and Clinical Challenges sections cover a wide range of topics, and include questions to challenge even experienced practitioners. The user-friendly online Tools and Calculators and Antiretroviral Medications reference will be frequently bookmarked and consulted by clinicians of all skill levels.  

Antiretroviral Therapy

In the session Antiretroviral Therapy—Interactive Cases From the Clinic(ians): A Case-Based, Panel Discussion, Conference co-chairs Cheever and Michael Saag, MD, presented an in-depth review of particularly challenging issues in current HIV medicine with which clinicians struggle. The attendees reviewed 10 cases in an interactive Q&A format that included topics such as selection of an initial antiretroviral regimen, pre-exposure prophylaxis (PrEP), and the differences between a Type I and II myocardial infarction. What should you know about starting ARV for an “elite controller” (naturally undetectable individual)? Should you prescribe PrEP to a seronegative partner of a successfully treated HIV patient?  

Opportunistic Infections

David Spach presented New Developments in Opportunistic Infections: Interactive Case-Based Discussion, which he described as a “tough topic” because the pace of development is much slower than the progress being made in the evolution of new ARV regimens. Spach covered many other topics, including a new recommendation for meningococcal vaccine in people living with HIV “that many providers probably didn’t know about,” according to Cheever, and when to use prophylaxis in patients with undetectable virus. As an example, in the past, patients who remained undetectable for long periods of time would probably be kept on pneumocystis prophylaxis if their CD4 cell counts remained low, but that is no longer the case. 

Opioid Epidemic

Petros Levounis, MD, who specializes in psychiatry, provided a compelling history lesson titled Opioid Crisis in America: A Big Mistake, an Aggressive Industry, a Tricky Brain, and the 16 Milligrams That Will Get Your Child Back to College. Dr. Levounis reviewed what the medical community got wrong but also what we have learned in the past few decades of addiction treatment. In his evidence-based review, he described some effective approaches that providers can use in addressing addiction in clinical practice. 

Watch this interview with Dr. Levounis as part of local news coverage of the relationship of HIV and the opiod epidemic.

Geriatrics

HIV care and geriatrics have a lot in common, noted Eugenia Siegler, MD, in her talk, Practical Aspects of Caring for People Aging With HIV. HIV increases the risk of frailty, even after successful ARV treatment, and older people with HIV often have significant impairments. Understanding the fundamentals of geriatric care, including assessments and screening of function, frailty, and cognitive impairment, can be of great benefit for HIV clinicians, especially as the HIV population in the United Staes ages. Siegler highlighted specific tools clinicians can use in caring for their older patients.

Tuberculosis (TB)

Susan Swindells, MBBS, whose clinical and research work takes her from Nebraska to Africa and Asia, gave a presentation New and Noteworthy in Tuberculosis Diagnostics and Treatment. “We don't’ see TB much anymore in the U.S., but it’s important we have the best diagnostics available,” said Dr. Cheever. However, TB infection is a common HIV comorbidity in the global epidemic.