ID Week 2020: Updates in HIV - Episode 5
Moti Ramgopal, MD, FACP, FIDSA, CPI, reviews data on high-dose versus standard-dose flu vaccines and additional findings in HIV care from ID Week 2020.
Moti Ramgopal, MD, FACP, FIDSA, CPI: In patients with HIV, we always want to see that high- and standard-dose flu vaccines are available. What’s this going to look like? Do our patients with HIV need a higher dose, and why? If that’s possible, what are the questions around this? The study looked at the findings of high-dose flu vaccine versus standard-dose vaccine. The question is, what’s going to be the implications of this study?
As background, high-dose influenza vaccines are approved for people over 65 years of age. But there’s no national guideline that recommends a high-dose vaccine in individual who are HIV positive. This study looked at the patients over 65 and investigated the effectiveness of high-dose influenza virus vaccine compared to a standard dose.
What did this find? It found that there’s a 50% relative reduction in protocol-defined influenza-like illnesses in the HIV clinic. This study was done in 2017 to 2018, and it suggests that patients with HIV over the age of 65 should now receive a high-dose flu vaccine. I think this is also an important study to recognize, that patients over  HIV positive, who use the high-dose flu vaccine have a 50% relative reduction in symptoms and influenza-like illnesses as a result. I think it’s quite important to recognize.
ID [Infectious Diseases] Week 2020 was challenging because most of it was done online. We were not there to actually be involved in the meeting. This type of disconnect can sometime lead to a disconnect in follow-up of clinical research. However, there are some really strong points of that came out of ID Week that I think we can continue to question.
Some of those with HIV have to do with weight gain. The weight gain continues to resonate. Not only the weight gain story, but the 2-drug therapy story; can we use 2-drug therapy earlier in rapid initiation? There were data on this presented at ID Week. There also will be further analysis of this question, where can we use 2-drug therapy?
Then comes the other option of injectable treatment. This is probably going to be evolving in the next 6 months. What’s the impact of injectable treatment on patient compliance, patient satisfaction? Now that we’ve seen the COVID-19 [coronavirus disease 2019] pandemic, what’s going to be the impact on new patients in care, returning patients to care, loss of care to follow-up because of the COVID pandemic?
These are all the post-COVID, post-ID Week challenges we expect to look at, and questions we look to answer in the next year. The COVID pandemic has really impacted HIV care. What is going to change in the next 6 months to a year? Now with all of these strategies, we need to readjust the way we did things previously. The role of telemedicine, the impact of telemedicine on HIV care is also going to be a good question.