I enjoyed the talk given by Natalia Edmiston on predictors of unplanned admissions.

It was surprising to note that studies have shown that most unplanned admissions amongst HIV infected people were due to multi-morbidity rather than HIV specific factors.

Natalie, also demonstrated that recommendations from the NSW studies is in keeping with other international studies such as National Institutes for Health and Care (NICE) guidelines.

Recommendations:

-          Clinicians should consider a mult-morbidity approach to care in treating people with HIV

-          Obtain a CIRS score at entry to care and update this annually

-          CIRS score is a very strong predictor of hospital admissions in HIV positive individuals

Presenter:  Professor Donna Mak

Given my own interest in gonorrhoea, it has been fascinating hearing what is happening in other parts of the country.

Here, Professor Mak presented the WA epidemiological data.

She noted that whilst rates remained highest in the historically high incidence ATSI group; these rates were relatively static.  The highest rate of rise of incidence was observed in heterosexual urban females.  The age group of highest incidence has shifted from the younger 15-24 age group to the 25-34yo age group.

They have an enviable program which allows them to assess the proportion of positive tests with the denominator of all requested pathology (apart from a single laboratory) and noted that the percent of positive tests are rising. 

From 1^st July 2017, enhanced surveillance for gonorrhoea has been implemented in WA; which involves a fax to the test provider with treatment recommendations and contact tracing recommendations plus some data collection.  If there’s no response, in certain groups follow up will be implemented: that is if the patient is under 16, tested by corrective services, ATSI, pregnant, a sex worker or client, outside Metro Perth, homeless or tested in hospital or by an after hours GP. 

Strains circulating in ATSI populations seem to remain sensitive to triple ‘zap packs’ of amoxicillin, azithromycin and probenecid; whilst urban populations are being treated in line with dual therapy recommendations.

Presenters:  Rekha Pai Mangalore; Shu Jin Tan; Prianka Puri; David Griffin.

The early bird not only got the worm, it got fungi, bacteria, a host of psychosocial and engagement challenges and Haemophagocytic lymphangiohistiocytosis.

The case presentation was a wealth of diagnostic and treatment dilemmas in late presenting, immunosuppressed patients.  All were from different parts of the world, and all proved Higgins Dictum will always hold true in immune suppression: Patients can have as many diagnoses as they damn well please.

Cases included disseminated histoplasmosis; HLH driven by HIV with concomitant nasal NK/T-cell lymphoma; a cryptococcal IRIS unmasked by ART initiation in an unscreened Australian gentleman; and a challenging tertiary syphilis involving gummatous and neurological disease. 

IVDU is the most frequent mode of HIV transmission globally

In Australia, Clean Needle Exchange Programs have reduced the risk

Comparison of IVDU V's no IVDU in the Australian Observational Database showed

IVDU  had 40 new diagnosis

IVDU with MSM had 56 new diagnosis

IVDU population had a higher risk of loss to follow up and mortality and viral suppression took longer than those whose risk was MSM only.

The IVDU with MSM group had the highest risk of virological failure and the highest risk of being lost to follow up

As people living with HIV age, the risk of  polypharmacy due to comorbidities rises. This presentation discussed whether medication review  by experienced HIV pharmacists would assist GPs to manage the complexities of drug interactions, adverse affects and adherence issues of ART and other co-medications.

PROM-GP study  is an ongoing nonrandomised prospective open study of 100 patients recruited from February 2016 to August 2016. The criteria was that patients had to have one or more of the following: be above 50 years old, on five or more medications including ARVs, have adherence issues or a recent hospital admission. A single 20 to 30 minute pharmacist/patient consultation occurred in the GP clinic. A report outlining medication related problems (MRP) and recommendations was provided to the GP. About 10% were reviewed by a panel. There was a follow-up at 3 to 4 months to assess whether the MRPs were resolved.

Results: 542 MRPs identified; 262 high/mod risk and 280 low risk. At 3-4 months 159 high/mod risk resolved and 162 low risk resolved. MRPs were varied with drug interactions, monitoring, education, toxicity, undertreated and compliance being the most common issues cited.

Panel review of 15 randomly selected patients (89 MRPs). Panel agreed with or even rated higher 73% of MRPs. 

Summary: PROM-GP study identified 2 mod/high risk MRPs and 3 low risk MRPs per patient.  62% of high moderate risk MRPs were resolved at 3 to 4 months. 

 Patients were very satisfied with the service.

The speaker commented that pharmacists love answering questions so encourage patients to ask away!