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.

Enjoyable last day, great morning sessions discussing PrEP and The way forward. I managed to sit through all presentations as I felt that I may pick up on some information which I found interesting and I could take home. I have truely enjoyed this conference and feel I have learnt so much and can't wait to share to anyone who will listen.

I feel I could make a difference in Refugee Health as I would like to commence education on my return. Where and how could I commence this? Currently, I believe NSW refugee nurses aren't discussing Sexual Health to the extent it needs to be discussed. I am going to talk about HIV and STI's at my initial nurse assessment and would like to talk about this conference to other Refugee nurses. Humanitarian refugees have already had a HIV test prior to coming to Australia. Depending on the country of origin, depends on the clients sexual health knowledge and from experience, I have found that most refugees and the CALD populations have had no sex education prior to coming to Australia. 

I would invite other organisations such as FPA and the Sexual Health service to help with education. Another possibility would be to educate at my outreach clinic at TAFE Newcastle. I am unsure of the numbers of NESB clients living in the Newcastle area with HIV. Don't forget to use interpreters for NESB's and give houndouts in their first language.

My role will now include discussion around safe sex, sexual health, informing clients of services which can provide testing, online websites and Apps and to provide this information in their first language if they are literate. 

2017 celebrates 30 years of ART's and I look forward to immersing myself in new literature and research. Very exciting research and clinical trials looking at durable remission/cure which may also include the 're-building of the immune system'.

Thankyou to ASHM for this scholarship which has made me so excited and full of energy to go and educate Refugee nurses around Australia in all that is offered regarding sexual health. There are so many exciting trials happening around the world and I am optimistic that someone will find a cure. I also want to look into the App world more to see how we can use the tool for research. Since HIV has been classed as a chronic illness, I wonder how clinicians are keeping their clients on a happy, healthy pathway since the clients are living longer? This is a discussion that we should have later. It is difficult to motivate clients to continue medication regimes when they feel well and we see this in psychiatry and clients with diabetes. Just 'food for thought' . Cheers Karinne

The session . On. HIV and cancer  was a rapid overview anD quite  focussed on the French experience -

HIV and cancer - DR Jen Philippe Spano -france 

RIsk factors- Age, HIV, oncogenic infections (HPV, EBV, HCV, HBV, HHV8), smoking, inflammation, sun (melanoma), low CD4
 
cART relative risk -non AIDS cancer with inc risk - inc Hodgkins 19 RR, anus and liver and lung - often occurs at YOUNGER Age  than HIV neg counterparts (Not inc risk of breast ca, prostate or colon ca) 
 
SMOKING is the trigger for the oncogenic viral infections to have their effects; 
-HIV contributes to inc risk of non aids cancer when adjust for smoking and oncogenic viral infections cf the general population;
 
LUNG cancer-in HIV pos pt in France, this is the highest ca diagnosed; 
Screening in the Gen pop- - CT scan- false positive nodules, may lead to false pos, used for diagnosis;
One study showed (not specifically HIV pts) annual low dose CT scan was better than CXR and resulted in reduced mortality 
 
-in France did a study in HIV pos smokers , low dose CT annually, 400 pts, 10 pts were diagnosed with lung Ca, mean CD4 high, problem  is the high  rate of other pulmonary comorbidities and false pos rate and biopsy, anxiety etc to investigate these further 
 
SKIN malignancies- eg BCC, SCC - should have regular annual examination;
RFx -Sun , FH, aging 
 
IN France, all patients in Gen population diagnosed with these cancers recommended to have HIV test . 

Was greeted by a Scottish Piper this morning on my way into the SECC. Really enjoyed the morning sessions and particularly enjoyed the 'Transition to adult care' by Pablo Rojo, PaediatricIan from Spain. His clinic tends to hold onto young patients until they are possibly more mature and are more likely to make their own appointments and continue their own care. Depending on their maturity and knowledge of their health care needs depends on them transitioning across to adult care. With over 350 posters to view after lunch, I spent the afternoon perusing and soaking up what I thought was interesting. I did met a lovely young Dr/researcher  from Mumbai a few days ago and he was exhibiting his poster. He wanted to explain his fabulous work to me. Title of his poster "Association of SLCO1B1 521T>C (rs4149056) with darunavir/ritonavir (DRV/r) plasma concentrations in HIV-infected individuals enrolled in the NEAT001/ANRS143 Study". Once he had finished explaining his research, I thanked him for his patience in explaining his very in depth and scientific work to me. I still can' t get over the lecture yesterday given by Dr Andrew Hill from London, his work inspired the audience and I want to research more about his work on my return. I look forward to tomorrow's sessions in PrEP and the way forward. I suspect I will enjoy these sessions. Cheers Karinne

Amazing 1st day at this conference, enjoyed most of the sessions, very scientific and to be totally honest, some of it 'over my head'. What did I learn and want to bring back to my peers in Refugee/Sexual health?

1) the push to have more community HIV clinics, where clients can access without the stigma attached to hospital clinics.

2) some research is looking at 'inplanontype devices which leak the drug slowly over a 12 month period and could be removed if unable to tolerate.

3) some research also showed that clients would prefer to self administer injections rather than taking tablets for their illness. Clients were able to forget about their daily regime of tablet taking, were able to be more spontaneous, felt the injections were safe and the fear of needles was not a major concern.

4) Implantable PrEP (silicon tubing implant) which would have a minimum 1 year insertion and then dissolve!!

5) Lower cost of medications for the treatment of cancer, HIV & Viral Hepatitis by Andrew Hill was very interesting. He discussed the cost of drugs in reality if made in India which is far cheaper than other options. I think we should all be looking at his research/discussions and possibly buying our drugs from India which I believe is legal in Australia.

Lastly, as you know, there has been an increase in Australia in HIV cases and I wonder if we are doing enough to educate our population? Clearly not. The last speaker of the evening was Linda-Gail Becker who talked out the 'kids born after 2000' the 'i-generation' who are using technology for everything. Maybe we should be educating  this population via devices!!

If there is something you would love to know and couldn't be here, let me know and I will endeavour to find out for you. Cheers Karinne and thanks to ASHM for my scholarship.

Thursday 21.07.2016 -Hormonal Contraception and HIV: A Review of the Science and Research, and their implications for Research, Programme and Policy.

Some studies suggest an association between specific hormonal contraception methods and HIV acquisition.   DMPA has been mostly implicated.  Information has come from observational studies alone. 

Chelsea Polis, US, presented an updated systematic review,updating their previous 2014 review, Ten new and 21 studies from past review were included in the analysis. 

 

Patches, rings, Hormonal IUDs:  no data

Implants:  very limited data on LNG implants, does not suggest increased risk.

OCPs [Oral contraceptive pills]:  substantial amount of data, does not suggest increased risk.

DMPA [depot medroxyprogesterone acetate ]:  substantial amount of data, newer data are increasingly concerning and converging around 1.2 -1.6.  

NET-EN [norethisterone enanthate (NET-EN)  ]:  limited data; less concerning than 2014 review, still worthy of investigation.  

Questions were raised regarding the reliability of the results considering the nature of the studies, none being RCTs in particular relating selection bias. ie. Women at higher risk for HIV choosing DMPA.  

Another delegate stated that pregnancy per se increases risk of HIV acquisition by around two fold and there is a need for reliable contraception; hence findings of any small increases in risk of HIV acquisition with DMPA should be considered in context.

Jared Baeten, US,  Update on ECHO Multi Centre,  Open Label, Randomised trial on HIV acquisition among users of different hormonal contraception methods [DMPA, LNG implant, Cu IUCD].

 

N=7800 f/u , 12 sites in Kenya, South Africa (9), Swaziland and Zambia.   18 mths per women. Quarterly follow up with usual standard of care.

Started in 2015 and will go on for ~36 mths.

This is a very important study.

 

Janet Hapgood, SA, Biological/immunological mechanisms for an association between HC and HIV

Very interesting presentation with regard to progestogens: different doses, methods of delivery, duration, inter-individual variation,  differ in their off-target effects via different steroid receptors which predicts different side effects.   DMPA has activity like cortisol. 

Conclusion: Collectively, clinical, animal, and ex vivo studies are broadly consistent and show that DMPA increases permeability of the female genital tract and compromises select FGT and systemic immune responses.  This most likely leads to increases in HIV acquisition via multiple mechanisms more so in some individuals than others. 

 

Andy Gray, South Africa,  presented on Interactions between HC methods and ART- updated systematic review.  This review was to update the evidence on which the WHO guidance and local policy is bases.

ART and HC effectiveness

·         Efavirenz – most clinically significant interactions were with Efavirenz. 

Implant users:  pregnancy rates from 5-15 per 100 w-y.   (c.f 0-2 per 100 w-y)

Combined oral contraceptive pill:  13-15 per 100 w-y. 

DMPA: not impactecd.

·         Nevirapine – No significant impact.

 

 

HC and ART effectivenessNo significant effect noted.

 

DMPA and PrEP – no significant effect. 

Conclusions include:

·         Current published data do not support limiting access to any HC.

·         Full range of HC options should be made available

·         More well designed studies are required to study drug interactions

 

 

Tagged in: AIDS2016

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