This will be my last blog at this Conference. I have been very privileged to have been able to attend CROI this year, my very first time (one of 25% of the first time delegates, I am told).
As the late Joop Lange had said, "Continue to do good Science"
It has been wonderful to meet up with my fellow "blogger" colleagues - Levinia Crookes, Julian Langton-Lockton, Jane Hunt, Marilyn McMurchie. We have certainly shared our experiences with one another.
There may be a few 'blogs' on this topic of PEP, but I will add my own perspective on this themed discussion.
Kenneth Meyer from Fenway Health, Boston was the Discussion leader. He talked about the challenges of PEP research (including the fact that guidelines are based on review of case series) and reminded us about the 2014 WHO guidelines on PEP to prevent HIV infections in adults, adolescents and children.
Four studies were presented :-
- Tenofovir/Emtricitabine Plus LVP/r vs MVC or Raltegravir for PEP: 2 Randomized Trials
- The rate of discontinuation of PEP and side effects were higher in patients allocated to the Truvada and boosted lopinavir group compared to Truvada and Maraviroc or Truvada and Raltegravir
- Rilpivirine-Emtricitabine-Tenofovir for HIV Non-Occupational Postexposure Prophylaxis
- This was the Australian study which concluded that STR of FTC/RPV/TDF was well tolerated with high levels of adherence and completion
- Significant intolerability of Efavirenz in HIV Occupational Postexposure Prophylaxis
- Management of Acute HIV After Initiation of Post exposure Prophylaxis : Challenges and Lessons Learnt
- The study suggested there is lack of clinical guidance in the clinical management of Acute HIV in the setting of PEP and that in the setting of acute HIV diagnosis after PEP initiation , recommendation to continue PEP until urgent review by HIV specialist where pros and cons of continuing vs stopping ART can be discussed
The Webcasts will be available soon and I would encourage colleagues to look at them.
The 4 speakers were from Spain, Australia, Thailand and the UK.
It was interesting to be aware of what is being used for PEP in each of the countries.
The speaker from Barcelona mentioned that they used Truvada and Raltegravir.
In Bangkok, Nevaripine and Kaletra are used.
In the UK, various regimes are used including Truvada and Raltegravir, Truvada and Kaletra.
In Australia, again, various regimes are used - 2 drug to 3 drug regimes depending on the risk according to our guidelines, as we already know. (I did not know this until today but one regime used in 1 centre is 3TC/TDF/d4T)
Several suggestions included:
1) That the full course of PEP should be given at first presentation rather than just the starter pack - ? to increase compliance.
2) 3 drugs should be used.
The issue of cost remains a consideration.
If already infected (very early infection) when initiating PEP, the question of what happens with very early treatment in this scenario remains.