ASHM Conference 2015 – Take home messages from a GP
The 2015 ASHM conference displayed all the teamwork I saw at the first conference which I attended 21 years ago. Great presentations and choices in themes. There was friendliness and a range of stakeholders and an ongoing respect for the roles and hopes of the different parties. The meaningful involvement of all the stakeholders and especially those most affected by blood borne viruses is unique to ASHM stakeholders and I have not seen such teamwork in all the branches of medicine I know.
In a nutshell, the big message for GPs from this conference is PrEP, PrEP and PrEP. PrEP means pre exposure prophylaxis. GPs will need to get ready for what appears to be a huge ground swell of demand for PrEP. They will need to know the use of Truvada for HIV sero negative gay men. Truvada for PrEP is not currently approved by the TGA and the PBS. So, GPs working in the MSM health area will need to know what mechanisms exist for current access.
Some issues will exist for a GP who considers prescribing PrEP, but the figures offered at this conference strongly suggest the outcome for ser negative MSM at high risk of HIV infection and on Truvada will be a lowering of new HIV cases.
The United Nations 90%:90%:90% goal concerning HIV was often referred to in presentations. The UN goal is:-
- 90% of people living with HIV will know their HIV status.
- 90% of people living with HIV will receive sustained anti retroviral therapy.
- 90% of people receiving antiretroviral therapy will have durable viral suppression.
A big message was that early ART treatment is recommended - start at the time of diagnosis. Regardless of CD4 count. Many presentations supported this. The START (Strategic Timing of AntiRetroviral Treatment) Study presentation concluded that:-
=Combination antiretroviral therapy (ART) should be recommended for all HIV -persons regardless of CD4+ count.
= The START Study results align the benefits of ART to the HIV-positive individual to the benefits of ART in reducing the risk of viral transmission from HIV – positive persons to non- HIV- infected individuals. So, clinicians should regularly discuss the current state of knowledge regarding when to start ART with all individuals with HIV who are not yet on ART.
The conference presentations reviewed current recommended ART treatment and some of their toxicities. An issue resulting from this is that all decisions to start ART should be made by the individual with HIV, in consultation with their healthcare providers and on the basis that they are fully informed and supported in their decision making. Patients makes the decisions and doctors give good advice for the patients to base their decisions on.
The conference highlighted the importance and difficulties in long-term follow-up of people with HIV. The option in the future of a national notification system might help in this regard, but there are currently greater efforts to evaluate past and current treatments.
Data at the conference strongly showed that mucosal damage from STDs lead to more easy HIV infection and the vigilance to treat STDs to decrease HIV spread cannot be over emphasised.
The new treatments for Hepatitis C genotypes 1 and 3 with daclatasvir and sofosbuvir have been approved by the TGA and are awaiting PBS approval.
Victorian data suggests that in Victoria, HIV and STD notifications are rising. There is evidence of ongoing increase in condomless anal intercourse with casual partners. There are also additional risk reduction practices in use in the community.
Geoff Symonds gave a presentation on gene therapy treatment for HIV. I found this fascinating and wonder how the role of gene therapy will pan out in the future. Great potential there.
At the ASHM AGM an overwhelming number of members voted to change its formal name and affirm its current role in covering HIV, viral hepatitis and sexual health. The new name is the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. The good news is the logo and the associated word ASHM stays there as well.
ASHM delivered a great conference.