Jamma Li

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.

Jamma Li

Jamma Li



I'm a third year advanced trainee in Clinical Immunology & Allergy in NSW. I'll be reporting back particularly on sessions relevant to HIV practice in suburban Sydney, as well as interesting international perspectives.

Data from the BMS-955176 Phase IIa proof of concept study was presented.
 
Short 10 day monotherapy were conducted for HIV-1 subtype B and C in treatment naive or experienced subjects to demonstrate virologic suppression. 1.64 log was achieved at doses above 40mg for B and 1.35 log for C.
 
The study also concluded comparable virologic control over 28 days with standard of care TDF+FTC+ATV/R with a 2.23 log fall in viral load at Day 28.
 
Still too early to tell I think.
Tagged in: EACS2015
Results were presented from the 0109 study funded by Gilead. Results from the study have been presented at multiple recent meetings.
 These results compared patients on standard of care Truvada plus boosted atazanavir to those subsequently switched to TAF/E/C/F (elvitegravir/cobicistat/FTC).
 
Follow up to 48 weeks supported at least non-inferior (perhaps superior) virologic control.
 
In relation to drug toxicity:
- The TAF arm had a change in creatinine of 0.00 compared to 0.03 mg/dL in the control arm from baseline.
- All measures of urinary protein were superior in the TAF arm.
- All lipids were increased in the TAF arm but investigators argued it was not clinically significant in light of a preserved total/HDL ratio.
- Improvement in BMD already at Week 24 and by Week 48, about 2% improvement, which in some cases was sufficient to move osteopenic patients to normal range.
 
Overall, I think TAF is very promising.
Tagged in: EACS2015

Whilst we should try to adhere to the guidelines re PJP prophylaxis for sustained CD4 counts over 200 prior to cessation, there is enough reason to not panick if a patient is having difficulty being adherent , and

1. Their CD4 count is above 100, or

2. Their CD4 count is above 75 and the viral load is <400

and

3. They do not have underlying lung disease or another cause of immunodeficiency.

This particularly useful to have in mind for those patients with difficulty with adherence and a Bactrim allergy! It might be easier to prioritise another medication as opposed to upset rapport by trying to administer pentamidine or atovaquone which are less efficacious.

Tagged in: EACS2015

Matthew Shields has already done an excellent summary of the three most interesting presentations in "Antiviral therapy 1".

I will try to add a few points without doubling too much over the content.

Follow up of all small cohorts were to 24 weeks only.

The first presentation was on dolutegravir 50mg bd monotherapy in virologically suppressed treatment experienced individuals with healthy CD4 counts (many on atypical regimens including PI monotherapy) in a 33 patient "spur of the moment" pilot study. The authors explained 1 failure through extenuating psychosocial circumstances.

The second presentation from France was on dolutegravir 50mg once daily monotherapy in an older (mean 47, duration ART 17 years) virologically suppressed treatment experienced individuals (1/3 mono, 1/3 dual, 1/3 triple therapy). Three treatment failures were linked to resistance mutations in integrase but those identified were not classically for dolutegravir.

The third study was DTG+3TC in 20 treatment naive individuals and marked as sponsored by ViiV, who will fund a clinical trial soon in the area. Patients had viral loads less than 100,000 copies/ml and CD4 above 200. All patients had viral loads <400 copies by Week 3 and <50 by Week 8.

My conclusions were:

1. Follow up to 24 weeks was a significant limitation to these pilot studies. Further work is needed.

2. Dolutegravir resistance is certainly possible.

3. First line two drug dolutegravir containing therapy may certainly be a possibility, either with lamivudine or otherwise, but data is currently insufficient to support this.

4. Dolutegravir monotherapy could be considered in treatment experienced patients who have burnt out other options but there isn't enough to recommend switching for simplicity of regimen.

5. Early virological suppression does not necessarily translate to treatment efficacy.

 

 

 
 
Tagged in: EACS2015

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I attended a few sessions of this course which runs on the first day. I hadn't read about the details beforehand, but it is very much in the style of an intensive workshop or refresher targeted towards specialist trainees or general or non-HIV physicians. I would certainly recommend attendance for these groups. Reference was also frequently made to the EACS Guidelines.

Both the toxicity session and the sexually transmitted infections session for instance comprised of a 15 minute clinical vignette of a moderate or higher complexity, followed by a 20-30 minute review on the topic. Particularly the toxicity session was ambitious and discussed about 20 items with traditional drug toxicity and all the metabolic complications.

 

Tagged in: EACS2015

The EACS Guidelines were updated and released in time for the conference.

If you have not viewed these guidelines previously, it might be worthwhile having a look via the link below.

They are quite distinct from, for example, the ASHM ARV guidelines. The EACS Guidelines almost present themselves as an exhaustive guide on how to approach all stages of HIV management, and even present flow diagrams on how to approach weight loss or discuss psychosocial issues in reasonable detail.

While they provide a good starting point, it is really important to remember that management often needs to be personalised or targeted to any given patient.

Download the Guidelines from EACS Society

 

 

Tagged in: EACS2015
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Blogging will be starting soon!

The conference officially opens tonight but there will be a few sessions that might be of interest this afternoon.

Thank you again to ASHM and pharma for making my time here possible.

Tagged in: EACS2015

RT @hepqld: Curing #hepatitis C is easy, and no longer needs a specialist to prescribe treatment. Community doctors play a pivotal role in…

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