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.

Tuesdayy afternoon provided a session of poster presentations exploring the complicated relationship between ARV treatment , excess weight gain and hepatic steatosis.

In summary ,

Weight gain in an HIV positive male is associated with twice the diabetes risk of the same degree of weight gain in an HIV negative male

Amit Achra from Kirby Institute presented DAD data the relationship between BMI and non AIDS related adverse outcomes. The results suggested that for CV risk both very low BMI (<18) and very high BMI (>30) were associated with an increased risk , and for non AIDS related cancers , risk was significantly associated with very low BMI and very high BMI.

An exercise physiologist from Massachusetts presented a study where overweight HIV positive patients were randomised to either be enrolled in an online weight loss and health coaching program or be in a control arm with minimal weight loss suppport. The results suggested the program was both cheap to run and successful in terms of significant weight loss.

A retrospective  analysis of a study where naive patients were randomised to start either raltegravir, boosted atazanavir or boosted darunavir plus 2 nucs looked at the predictors of excess weight gain. Interestingly they were black race , higher baseline disease severity and use of Raltegravir. There was a lot of discussion about the possible explanation of Raltegravir falling out as a predictor.

Interestingly a study was presented were HIV positive women on NNRTI or PI based regimens were randomised to either stay on th regimen or swap to Raltegravir regimen. They looked a biochemical markers of hepatic steatosis , Chi3L1 and adipokine adiponectin. It was interesting that both these markers droped (suggesting decreased steatosis) in those that switched to Raltegravir.

Finally a study looking at patients swelling from a Efavirenze containing regimen to a Raltegravir regimen appeared to decrease their steatosis as measured by a CAP score, (Controlled Attenuation Parameter , an add on process done with a fibrous scan)

So Raltegravir seemed to lead to weight gain but less hepatic steatosis , a result that seems to pose more questions than it answers.

Tagged in: CROI 2017

Presented by Dr Phillip Read, Sexual Health Physician and the Acting Director of the Kirketon Road Centre in Sydney’s Kings Cross who spoke about the rising rates of Syphilis and co- infection in HIV+ve men. There are increasing rates of syphilis notifications in the MSM cohort, with more than 50% of notifications in this group. In Canada, there is a 300x increase in rates of syphilis associated with HIV infection. In OECD countries, there are increases evident in the male to female ratio of syphilis infections. 

Other points that were discussed included 'PrEP' for syphilis in a proof of concept study which used doxycycline 100mg daily. It demonstrated a 73% reduction in infections, with minimal side effects.
Also, a study that showed that 2 weeks of doxycycline showed no difference in cure rates of syphilis when compared to a single benzathine dose. That's reassuring for myself when I've had to use that regimen for those who can't use penicillin. Interestingly, another study showed that a 3gm dose of amoxicillin had a 95% cure rate for syphilis. 
The take home message for me was about treatment of syphilis in HIV+ve individuals. Time to come clean... I have to admit that I have always been in the '3 is better than 1' boat however a study in the U.S. Military Cohort showed no difference between 1 dose and 3 for cure. Interestingly, 40% of syphilis treatment in Australia was with enhanced therapy (ie 3 injections) vs guidelines for acute/early syphilis. So there are many in my boat, but I think it's time to jump ship.
Twitter response: "Could not authenticate you."