ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
ASHM - A GP's perspective
Good evening everyone! Here are some ‘take home’ points from the conference today:
1. The HPTN052 trial did not stop in 2011 - contrary to popular belief. This landmark study published interim results in 2011 showing a marked (96%) decrease in HIV transmission rates in discordant heterosexual couples when ARV therapy was commenced early versus delayed therapy.The study continued, but in light of the new data all participants were offered ARVs.There have only been 8 HIV transmissions since then on the study. 4 of these were people who acquired HIV at the same time as commencing ARVs. The other 4 cases were in the context of treatment failure with detectable viral load.In other words no transmissions have occurred when HIV replication is suppressed – exciting news!
2. We now have irrevocable evidence that all people with HIV should be offered antiretroviral therapy regardless of CD4 count. However the WHO have yet to update their guidelines, and the logistics of global access to ARVs are massive.
3. Doxycycline “syphylaxis” is effective and well tolerated. In a small study of people taking doxy 100mg daily for 48 weeks, there was a 77% retention rate and a 73% decrease in STI acquisition (gono, chlamydia and syphilis). Worth considering in high risk patients.
4. For early syphilis only one dose of benzathine is required for HIV pos patients (not 3 as previously recommended).
5. 5-15% of pregnant women worldwide have a curable STI, but only 5-6 countries have a documented policy of screening for STIs during pregnancy. Globally many women attend a health care provider just once during their pregnancy, and symptomatic STIs are treated on the spot. Given that 80% of STIs are asymptomatic many are missed and can cause adverse pregnancy outcomes and MTCT. We need to improve pregnancy outcomes in high burden low income settings, including making point of care testing for STIs readily available and affordable.
Really enjoyed today's informative and cutting edge sessions, ASHM have set the bar high!, looking forward to tomorrow.
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