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.
The Pre congress workshop was aimed at junior specialists and professionals in training and followed a theme of challenging case presentations followed by an overview of the topic by an expert. Women living with HIV seems to be a problem area in London mainly in black African backgrounds. The topic covered was contraception and take home messages were that women tend to go to their GP for contraceptive issues and tend not to disclose their HIV status and end up getting a contraceptive method which interacts with her ART.
There seems to be trend of prescribing Truimeq for women of childbearing age despite the fact that there is no data on teratogenicity of Dolutegravir, in case they have an unplanned pregnancy. Generally regimes are unchanged if they do fall pregnant mainly because by the time the pregnancy is discovered it is usually past 6 weeks. A study is currently underway in African pregnant women on Dolutegravir looking at teratogenicity and so far there have been no reports.
Caesarean section rates seem to be still high in regional centres despite viral suppression to undetectable levels. This is party accounted for the number of women with a previous section but they are hoping it will go down in future. Considering the poor compliance of women coming back for contraception at 6 weeks post partum, intracaesarian IUD insertion had been effective both in the USA and Africa with expulsion and infection being rare and may be used for an occasional poorly compliant woman.
The session on 'Chem sex' was quite interesting as I learnt a lot of new jargon relating to sex and drugs. There is about a 15% rise in IVDU among MSM in UK in the last decade giving rise to the risk of spread of HIV, HBV, HCV, HDV, and of course STI's. Slamming is another word used for using psychoactive substances in a party or sex settings. A qualitative study done in Paris showed that men using these drugs were unaware of their HIV and HCV status rates being as high as 40-60%.
When considering the amount of MSM turning up at the clinic on Monday afternoon for PEP after a 'wild weekend', I think that chemsex would be a potential problem in Sydney and other major cities in Australia very soon. Repeated HCV infections are a major problem in this group.
For both contraception and chemsex, a most valuable site is the Liverpool drug interactions website. www.hiv-druginteractions.org
STI session was quite interesting and increased rates of gonorrhoea, Chlamydia and syphilis were universal all across Europe in the last couple of years.
Funny fact - In the olden days gonorrhoea was treated by hitting the penis with a bible! :)