Today there were a few other abstracts presented about Prep.

A Siegler presented a demonstration project about a home testing system for Prep in the US. This involved sending out kits for STI testing and taking a few drops of blood for tests as wel as a questionnaire. Interesting idea- parts of which might be useful for future planning of Prep systems. 

P-C Crouch presented a San Francisco implementation of non-physician based Prep program using nurse and peer support volunteers. This has been successful in delivering Prep to a lot of people there. Again, food for thought about how we may be able to do things differently, even though their model is really in response to the barriers in their health system which are different in Australia. Since November 2014, they have screened over 1250 people with 95.5% enrolment and 71% retention and no HIV seroconversions.

I Zablotska presented details of the EPIC- NSW Prep implementation - good to see this being presented on a world stage and we all await the results of this and the other state based programs.

R Heffron presented data about renal screening- comparing the 3 months screening in the Partner Prep study to the Partner demonstration project whi did it six-monthly. There showed no difference between the two, so it supported the US CDC guidelines of six month renal screening being recommended.

All in all, some things to think about as we use more Prep.

At the Prep symposia yesterday, here was discussion about microbicides research- which agents to use and wil there be a need with oral Prep proven effective, the long acting injectables and infuseable (VRC01) agents as a possible for the future, It was also mentioned the research around rectal microbicides, suppository being investigated, the idea of a douche that might deliver the agent and ongoing research in vaginal rings.

 

Overall a very informative an interesting conference- the best I have been to. There is a sense that the world is coming together demanding the best treatment and access for all. The program's being rolled out in developing countries can be very impressive which should inspire us to reach and exceed the 90-90-90 targets.

J-M Molina this morning presented the Ipergay extension study results. Participants of Ipergay were offered to go onto an open label extension study to remain on episodic use of Prep. Ipergay was the placebo controlled study of use of truvada 2-24 hours before and 24 and 48 hours after sex as Prep. Some new participants were also enrolled. There were 362 participants. There was 1 HIV seroconversion in a person who was not taking the Prep. The mean pills per month taken was 18, There was no significant increase in number of sexual partners. Self-reported adherence was slightly improved. There was a significant reduction in comdomless receptive anal sex, but the STI rate remianed the same. 

This study is very assuring for us in Australia as there are several such programmes that either have or about to begin. It is good to know that we should expect high levels of risk reduction with Prep, even though there is still active debate about episodic vs daily Prep. It would appear that episodic Prep is also very effective.

There were also many posters on Prep displayed today. INterestingly, there was a study from Amsterdam comparing acceptability of episodic versus daily Prep. 73% of participants preferred daily Prep. These men tended to be younge and had more sex. 

I think it would be good to have both options but I suppose patients may do it anyway.

Another poster from Thailand using Prep in MSM found it feasible as they were able to deliver Prep for USD1- which includes cost of their generic drug and associated services. I am to sure if this was a daily cost or per visit cost.

 

Many Prep posters about acceptability in many settings around the world- some in MSM, some in young females, some about newer topical methods, All ver promising for the future and nice to see many places taking Prep seriously as a method of eliminating new HIV infections

several prep presentations on Tuesday covering different aspects of prep.

Brocca-Cofano presented a study about using maraviroc on infant macaques as prep. The conclusion was that it offered no protection from SIV in infant macaques. This may be different in human populations.

Gulick then presented a phase II study on maraviroc tolerability in US women. There were 188 women in the study, 160 completed. This was a four arm double blind study comparing maraviroc, maraviroc + TDF , maraviroc + FTC , and TDF + FTC . This was a purely safety and tolerability study over 48 weeks and there was shown to be no difference between the four arms.

McGowan presented a study about the persistence of Rilpivirine after a single long acting injection. N=36, they compared plasma and genital fluid and rectal fluid  and compared either single dose, 600 or 1200mg vs 1200 every two months. In 7/7 of the participants who had 1200mg im single dose, there was Rilpivirine present in their genital fluid and plasma after 18 months. This raises issues about he use of this as prep due to concerns about development of resistance due to this long residual level of Rilpivirine . 

Grant presented a study about the benefits of prep relative to drug resistance. They showed that across all prep studies, the risk of drug resistance was very low 0.05% risk. Most of the resistance occurred in people who were HIV infected at entry into the trial. They concluded that the benefit of prep far outweighed the low risk of drug resistance. As this occurred mainly at the start of prep, it was important to exclude anyone who might have and acute vital illness from starting prep to ensure that it was not a HIV infection. It was also suggested that it might be important to do HIV Ag testing or dna before commencing prep.

Brown presented an interesting study about the use of dapavirine vaginal rings from the aspire study. The level of drug level in the ring after use gave an idea about adherence levels. After some stratification, they found that in the moderate to high adherence women, the risk reduction improved from 27% to 56-75% risk reduction.

late breakers

hosek presented data about the safety of prep in 15-17 yo msm in the US. The numbers were small -60 due to recruitemnt and consent issues but the conclusion was that it was are to use with no real differences. There is the bone data presented in the past that still needs clarification.

Rawlings presented data on prep use in the US between 2013-2015. This data was collected from prescription data with PEP and treatment prescriptions excluded. Almost 80,000 people used prep in this period, with a significant increase in men using prep in the last two years. The study also looked at seroconversion rates across multiple prep studies. They had about 8,500 participants and there was  a seroconversion rate of 1.03% in men, 0.25% in women.

The theme of access equality rights now is palpable. There is a mood of activism to overcome these barriers in HIV . Quite exciting to be around!