Optimising Art for prevention in clinical practice

This entertaining session presented a number of varying cases to highlight the promises PrEP may bring but also the pitfalls.

It emphasized the importance of "hearing the patient", as to their psychological and sexual needs.

In South Africa, Dr Abdool Karim expressed that women need PrEP type product that they can initiate themselves , independent from their partners knowledge , as a study of seroconversion rates still revealed 9.1%seroconversion in young women. She also reported an association between HPV acquisition and HIV acquisition.

Dr Raphael Landovitz from L.A. Introduced a new term "the dribble effect", which refers to lowering of serum levels of Truvada as some doses are missed , but those lower drug doses may still give some protection. It is still to be determined what the ideal treatment protocol is and also what are the lower serum levels that still offer some protection, before development of resistance may occur.

So far  Truvada toxicity has been minimal with most serum creatinines recovering  to normal.

a major issue will be cost as it is not yet funded in Australia.

 who will be keen to take it and how often it will need to be taken was explored in different scenarios which included the discordant MSM couple, the monogamous African woman, and the bipolar personality.

Dr  Landovitz stated the numbers were too low in the Ipergay trial to determine the efficacy of that regime.

we have lots to learn in the era of PrEP but it appears to be very promising as another way to prevent  further HIV seroconversions