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.

Gary Prott

Gary Prott

I’m originally from Scotland. I’ve worked extensively in community HIV /AIDS care in New York City from 1992  - 1997. My current role is as CNS at RPA Sexual Health. I was previously at the Albion Centre, also specialising in sexual health and HIV management.


 


 

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It was the final day of this  truly wonderful global congress. 

Chloe Orkin of the Department of Infection and Immunity at the London Hospital co-chaired the opening session of the day and discussed some great advances in HIV research this year including:

. Phase 3 TDF v TAF trials

. Injectable PrEP

. ?generic 3TC/TDF

. New delivery methods

. New molecules

Sheena McCormack of the MRC clinical trials unit at University College London provided us with PrEP updates and effectiveness, highlighting:

. the overwhelming evidence of its efficacy

. Population effectiveness not compromised by resistance

Based on the evidence, she concluded that moving into the future, there will be more drug choices for PrEP, different regimen choices (episode driven) and a multitude of delivery methods (vaginal rings/injectables).

One of the day's most thought provoking presentations was delivered by Keith Rawlings from Gilead Sciences medical affairs. He reported that despite a steady increase in PrEP use since 2012, data showed there was a huge discrepancy in those who accessed it. He stayed that it was heavily weighted towards middle class caucasian MSM.

This was despite an increased lifetime risk of HIV acquisition of:

. 1:20 for African American males

. 1:48 for African American women

. 1:48 Hispanic males

 

 And when broken down further:

. 1:2 African American MSM

. 1:4 Hispanic MSM

as compared to 1:11 in Caucasian MSM

FTC/TDF for PrEP has been disproportionately low in the higher risk populations in the USA.

It was recommended that to effectively decrease new HIV infections, messaging and services need to be more focused on those populations with the greatest disease burden. 

It's been an incredible 4 days here in Glasgow which has sadly come to an end. I look forward with great anticipation to the next Glasgow HIV Drug Therapy Congress 2018 and anticipate further advances will continue globally in HIV management thanks to the many innovative and brilliant researchers working in the field.

 

The weather has been very kind to us and has been very un-Glasgow like since the start of the congress. For the second consecutive day, a piper welcomed us to the SECC.

It's truly humbling to be in the presence of all these wonderful researchers and inspiring to see all the advances being made in the management of HIV. The focus of many of today's presentations was on HIV and ageing, associated co-morbidities, co-infections, malignancies and mental health. The need for improved screening programs was a recurring theme.

We were again reminded of the 2020 goals which aim for 90% of people with HIV being diagnosed, 90% diagnosed on treatment and 90% on treatment with an undetectable viral load. 

Highlights of the day for me included an interesting presentation on 'ARV Optimisation to meet patient needs' by Mark Nelson from the Chelsea and Westminster Hospital. He referenced a questionnaire/survey conducted by Redlin in 2014 comparing what health care providers and patients considered important when it came to HIV care and ARV therapy. Interestingly, efficacy of treatment was ranked highest and cost ranked lowest by both arms. 

The day was concluded by Fiona Mulcahy of St James Hospital who presented a complex case study of a young immigrant woman with a new HIV diagnosis who was planning pregnancy with her new partner of unknown HIV status. Disclosure was certainly an issue and the consensus was that he should be tested as soon as possible and that she should commence ART. The various options for reducing transmission of HIV to the male partner were discussed, including PrEP. There was some debate and conflicting opinion on how the couple should proceed, though the presenter suggested she would recommend natural conception as long as her viral load was undetectable. 

The congress sadly concludes tomorrow. There are some  exciting presentations to look forward to, including, but not limited to PrEP, the future of ARV's, drug interactions and new drugs. 

 

Another captivating day of presentations and lectures.

There was robust discussion regarding treatment strategies during the morning session.

Christian Callebaut from Gilead Sciences clinical virology presented on the resistance profile of treatment experienced HIV infected patients switching to elvitegravir/cobistat/emtricitabine/ tenofovir alafenamide plus darunavir. This population is known to have a high pre-existing resistance profile. 

. The regimen was found to be statistically superior to staying on baseline regimen @ 48 weeks

. Treatment was simpler 

. More convenient option for treatment experienced patients on complex multil pill regimens

Chloe Orkin of the Department of Infection and Immunity at the London Hospital, presented new clinical data on switching from rilpiravine/emtricitabine/tenofovir alafenamide and its safety and efficacy through 48 weeks.

. Found to be very effective

. Increased rates of viral suppression

. No emergence of resistance mutations

. Well tolerated

. Low incidence of adverse events

. Low discontinuation rates

. Improved renal and bone safety

A very full day culminated in spending time with other Australian delegates.

Busy day ahead tomorrow, starting off early with an industry symposium on helping patients stay the course.

What a fascinating and informative first day on a beautiful, if a little bit cold Autumn Glasgow day!

In one of the early sessions, Ian McGowan of University of Pittsburgh discussed innovations in long acting ARV's for both HIV treatment and HIV prevention (PrEP).

Phase 2 studies for intramuscular injections and implantable devices look promising and are now moving into phase 3.

The combination of two long-acting injectable antiretrovirals, cabotegravir and rilpivirine given once every 4 or 8 weeks;

. were generally well tolerated treatment regimens

. maintained viral suppression  in HIV positive patients 

. prevented HIV in negative patients. 

. had high patient satisfaction levels

Sally Jewsbury of Manchester NHS foundation trust followed with a complex and difficult case study presentation involving a female Zimbabwean patient with multiple co-morbidities that ultimately had a happy ending due to her and her teams dedication and perseverance. I had the pleasure of meeting Sally personally during lunch. 

A moving tribute was made to Joep Lange and Jacqueline Van Tongeren followed by an inspirational presentation by Anthony Fauci from US National Institute of Allergy and Infectious Diseases. His focus was on implementing proven scientific tools to end the HIV/AIDS pandemic, highlighting the great advances made since the first  HIV notifications in 1981.

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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