Presentation by Andrew Carr.

Bone loss in 1st year of ART is a well established fact.

Loss is more on tenofovir containing regimes 2.4-3.8%  non tenofovir 0.7-2.5%.

Compare to 1 year 10mg prednisolone 0.8 -3% loss

PREP tdf-ftc

4RTC's show 0.5-1.5% loss BMD over 12-30 months!

          Reversible  if stopped  after 1 year

             Reversibility not established for longer periods, prep may be long term

Proportion of those with greater bone is uncertain

            >3% loss at hip and LSS in 25-50%

Non adherence issues in early RCTs , so bone loss may be underestimated.

Study 36 men taking TDF-FTC PrEP on prelude trialNSW,av age 38, av weight 79.9,TDF exposure pretrial 6months.

Average BMD loss - 2.2 spine,-2.5 fem neck,but,approx 45% lost>3%, 25% lost>5% BMD

Study limitations :no control,no women,some loss attribuible to age, 1 year data only,no PK data

Needs:

Longer f/up, data on secondary causes of BMD loss,more patients to identify risks for the greater loss group

 

 

 

 

Presentation of PraveenaGunaratnam

Data  from the National HIV Registry

Period 2005 to 2015

Reduced representation of plwha from Sub Saharan Africa, 30/100,000 in 2010,15/100,000 in 2014

Increasing representation from  nth Asia, 2/100,000 in2005, 7/100,000 in2014

Increase in Asian born MSM hiv rate from 6 to 15 % of the total in the 10 year period,43 % overseas born  MSM with hiv born in Asia.

Sub Saharan Africans and South East Asians still have high rates of late and advanced diagnosis app 50%.

IMPLICATIONS

Need to reduce barriers to health care access

Evaluate interventions tailored towards different communities, specially with respect to TasP, prep

Continue to gain epidemiological and behavioural research and monitor changes in HIV related practices, health outcomes and prevalence