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.

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Day 2 of the HIV Drug Therapy Congress in Glasgow began with an excellent presentation by Dr Julio Montaner  from the British Columbia Centre for Excellence in HIV/AIDS on “HIV treatment as prevention: from a research hypothesis to a new global target and beyond.”  He argued that the “treatment as prevention” approach reduces morbidity, mortality and HIV transmission, and is also the most cost-effective approach to managing the HIV epidemic.  Is the current UNAIDS target of 90:90:90 by 2020 feasible?  This would equate to 91% of people with HIV diagnosed as HIV positive, 81% of all people with HIV being on ART, with 73% of all people with HIV being successfully virally suppressed.  The current global figures fall far short of this, being 57%, 46% and 38% respectively. 

Dr Montaner emphasised the importance of being alert to picking up clusters of increased incidence in specific populations quickly, with efforts to identify networks, increase contact tracing and testing, and make use of PrEP and rapid institution of treatment.  He also talked about the importance of political support and mentioned previous tendencies of government in various regions to lose enthusiasm for addressing the HIV epidemic when rates appeared to be waning.  He said that the piecemeal approach won’t work, and control of the HIV epidemic globally is clearly the work of a generation, not a few years. 

 

Dr Jens Lundgren of the Rigshospitalet in Copenhagen reviewed the insights gained from the START study and the substudies related to it.  This study was especially important in that it is globally applicable, being conducted over 4 years in 35 countries (250 sites), with a sample size of 4600 people, randomised to either early ART or deferred ART (until CD4 count less than 350cells/mm3).  It has changed the management of HIV globally, with all subsequent guidelines advising immediate rather than delayed treatment.

 

Some of the unexpected results of the START trial were that in the deferred arm there were both increased rates of opportunistic infections (although CD4 counts were often in the order of 500-600) as well as increased rates of various malignancies.  It had been hypothesised that the immediate treatment arm may see a reduction in CVD risk due to reduction in inflammation, but this was not the case – in fact there was no change in CVD risk.  A substudy published earlier this week in the Lancet Respiratory Medicine journal showed that, if anything, the deferred arm had reduced rates of COPD.  Another substudy on bone mineral density has clearly shown that early treatment leads to more accelerated decline in BMD. 

 

Later in the day, Dr Jean-Michel Molina from Saint-Louis Hospital and the University of Paris presented a case study of the use of PrEP in a thirty year old female patient with a HIV-positive male partner.  The various options for reducing transmission of HIV to the female partner (who wished to become pregnant) were discussed; the most important point being of course effective viral suppression of the male partner’s HIV, as well as condom use and also the possible addition of PrEP for the female partner as an additional precaution when she wishes to conceive.  The previously-favoured approach of IVF with sperm-washing was no longer seen as the most appropriate treatment, as rates of pregnancy are much lower with this approach than with natural conception and the panel commented that an undetectable viral load was reliably associated with lack of transmission of HIV to the negative partner in studies of serodiscordant couples as well as their clinical experience of similar cases.

Today began with an interesting talk by Prof. Julio Montaner. He spoke about HIV treatment as prevention (TasP) – I found it interesting that based on a couple of models (from Hlabisa, Africa and BC, Canada), for every 1% increased coverage (with ARV and undetectable VL), one can estimate a 1% decrease in HIV incidence.


Prof Montaner also presented research on the HIV strains found in British Columbia. Phylogenetic studies of the strains found show that, even with high rates of diagnosis, treatment and viral suppression (Vancouver on-track to reaching 90/90/90 goals by 2020), significant clusters of new infections still continue to occur, and that investigation, prevention and treatment strategies must focus on these clusters. Contact and partner tracing were strongly emphasised.

 

 

Jens Lundgren spoke next regarding the START (early ART) study update.

-       Hazard ratio of 0.43 of serious AIDS/non-AIDS events in early treatment arm (compared with delayed treatment) – so unblinded early.

-       Significantly decreased rates of OI in early treatment arm.

-       Cancer occurrence had a 64% risk reduction in early treatment arm.

-       No evidence of a change in hazard ratio for cardiovascular disease; no evidence of a change in FEV1 between arms; no evidene of different in neuropsych testing results.

-       Bone mineral density testing showed total spine BMD decreased in immediate vs delayed ART – clinical implications unclear.

 

Chloe Orkin spoke about a couple of studies involving TAF – study 1089 involved switching from TDF to TAF in those virologically suppressed. n=663; all initially on TDF/FTC + 3rd agent. Half had TDF switched to TAF.

-       No difference in rate of discontinuation or adverse events between arms.

-       No difference in efficacy at 96 weeks – TAF/FTC noninferior.

-       Average EGFR and BMD improved in TAF arm.

-       Slight increase in LDL/TC in TAF arm, but no change in total cholesterol:HDL ratio.

 

Finally Patrick Sullivan spoke about the importance of convenience in improving HIV care. He discussed strategies including:

-       Integration into routine clinical encounters

-       Self-service options

-       Home delivery of investigation/treatment/PrEP

-       Reminder systems for routine screening.

His team has developed a mobile app called Healthmindr (still under trial and only US-based I think) that helps with behaviour screening, PrEP assessment and advice and reminders about STI screens.

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They’re also trialling STI testing and PrEP at home – involves initiation and follow-up to three months in the clinic, then visits and monitoring after that can be done at home (a kit is mailed and self-collected swabs/FCU/blood tests, as well as survey). Acceptability has been high and sample quality adequate.

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.

Was greeted by a Scottish Piper this morning on my way into the SECC. Really enjoyed the morning sessions and particularly enjoyed the 'Transition to adult care' by Pablo Rojo, PaediatricIan from Spain. His clinic tends to hold onto young patients until they are possibly more mature and are more likely to make their own appointments and continue their own care. Depending on their maturity and knowledge of their health care needs depends on them transitioning across to adult care. With over 350 posters to view after lunch, I spent the afternoon perusing and soaking up what I thought was interesting. I did met a lovely young Dr/researcher  from Mumbai a few days ago and he was exhibiting his poster. He wanted to explain his fabulous work to me. Title of his poster "Association of SLCO1B1 521T>C (rs4149056) with darunavir/ritonavir (DRV/r) plasma concentrations in HIV-infected individuals enrolled in the NEAT001/ANRS143 Study". Once he had finished explaining his research, I thanked him for his patience in explaining his very in depth and scientific work to me. I still can' t get over the lecture yesterday given by Dr Andrew Hill from London, his work inspired the audience and I want to research more about his work on my return. I look forward to tomorrow's sessions in PrEP and the way forward. I suspect I will enjoy these sessions. Cheers Karinne

 

One of the highlights of the first day of the Glasgow 2016 HIV Drug Congress was a brilliant presentation by Dr Andrew Hill of St Stephen’s AIDS Trust in London on the cost of novel direct-acting antivirals (DAAs) for chronic hepatitis C (HCV).  His group extracted data from an online database of Indian export ledgers for per-kilogram prices and volumes of DAA active pharmaceutical ingredients (APIs) exported from India over Jan-Jun 2016.  Generic DAAs are being produced by manufacturers in India and a limited number of other countries under voluntary licences offered by Gilead, the originator company of Sofosbuvir; however, these countries only represent 50% of the worldwide epidemic and current high prices elsewhere limit access to DAAs both globally and in high-income countries. 

 

Dr Hill and his research team combined the cost of per-pill API requirements with estimated costs for formulation and excipients and packaging, and finally a profit margin of 50% was added to estimate a price at which generic producers could profitably enter the market. 

 

Their graphs of cost per kilogram of DAAs showed that production costs for these medications have been falling rapidly since 2015.  The difference between generic production costs and the current price paid for non-generic DAAs in developed countries is enormous.  For example, 12 week treatments of sofosbuvir can currently be manufactured for $62, sofosbuvir+ledipasvir $96, daclatasvir $14, sofosbuvir+velpatasvir $181-216.  These prices include the estimated 50% profit margin for generic suppliers.  In contrast, the cost of a 12 week course of sofosbuvir available via the non-generic manufacturer in the US is $49,860 – 84,000; of daclatasvir is over $50,000; of sofosbuvir+ledipasvir is $56,700 – 94,500; and of sofosbuvir+velpatasvir is $74,760.

 

Dr Hill made the point that the estimated generic prices for DAAs are comparable to those that allowed massive treatment scale-up in HIV/AIDs.  He also commented that governments are often unaware of the degree of mark-up being charged on medications they are purchasing, although this information is in fact available via the methods his study team used.  He stated that the common reaction to talk of these huge profit margins was that pharmaceutical companies need the money to invest in further research and development: his response was to state that Gilead, for example, posted a profit of over 10 billion dollars in the past year, and to pose the question: exactly how much money do such companies need to make to fund further research and development?

 

Julio Montaner has just presented his assessment on the roll out of 90:90:90 focusing on Canada but with global observations. The take home message is that transmission reductions are associated with greater roll out of therapy and higher rates of undetectable viral load. Achieving this is not easy and even in developed settings. People are now being explicit that 90:90:90 really means that only 73% of people with HIV are immune suppressed.

David Cooper has asked about what other strategies might be needed by countries with high rates, of treatment and viral suppression, to get incidence down. Julio, refereed to the the phylogenetic clustering work they are doing as a way of getting a better handle on this. He cautioned that PrEP may miss clusters.

Julio also discussed phylogenetic testing. Canada has high rates of prosecution for HIV transmission and they they are trying to change that. Changes in government may facilitate that. They got agreement form the Attorney General that data would not be used for prosecution. 

This has resulted in data being collected without the fear of prosecution. They are hoping to adopt the same process across Canada. It might be useful to look at this in Australia as jurisdictions and research groups look to increasing phylogenetic monitoring.

 

 

 

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Glasgow HIV 2016 has just opened.

It was interesting to hear new-comers to this meeting reflect on the three excellent presentations in the opening: Clarity, different perspectives, and reflections mixed with predictions. The sessions will be up on the Conference website shortly.

Tony Fauci, giving the Joep Lange and Jacqueline van Tongeren Memorial Lecture. Ending the HIV/AIDS pandemic: follow the science, reflected on the changes that have come about since he entered the field in 1981, following the publication of seminal articles in the MMRW. Fauci indicated that this is when he decided to change his career trajectory and concentrate on the, as then un-named, phenomenon which would become HIV.

Fauci sprinted through 30 years of HIV to focus on the more recent research which has redefined ending HIV. Namely the recognition that treatment reduces virus which in turn reduces transmission and that knowing ones status allows for interventions. But he did not stop there. He went on to cast and eye to the horizon and identified two areas where science has significant contributions to make.

HIV persistence, or stopping persistence, is a holy grail. This comes in two forms, eradicating HIV where HIV is made dormant while treatment is administered, yet re-emerges when treatment is stopped or controlling rebound, where interference at binding or replication sites reduces proliferation. This individualised therapy has shown to be useful in this strategy in cancer treatment and it has potential in HIV.

HIV vaccines, whether therapeutic or preventative are of course what everyone is hoping for. Fauci presented some realistic steps which are being made to transition vaccines from 32% effective to more like 50% effective, a point which he suggested could make significant inroads in reducing transmission, particularly in endemic settings and in combination with other strategies. He also discussed a number of new vaccine initiatives.

He ended with neat summary of why vaccinologists have not yet been rewarded. This I thought was a poignant rationale for continuing with vaccine development in the absence of any hitherto prizes. Most vaccines mimic the actual process of disease and immune response. That is not the case in HIV, so the vaccinologist needs not to copy the virus, but be much smarter than it.

 

Andrew Hill

Spoke about the potential to improve treatment access through the greater use of generic drugs. I can’t help thinking every time I hear Andrew talk that he is simplifying something in the greater economics and practicalities of capitalism or financial markets. But his arguments are very compelling.

Interestingly Andrew inserted discussion about Australia’s funding for hepatitis C treatment. Having just come from the USA where I was asked about details of the same, it seems to me that there are very different mechanisms in place in different countries which can result in very different approaches to price setting.

Two years ago at this meeting Andrew suggested it might be in the interests of the NHS budget to make a two pill (rather than single pill) regimen available to the UK public through the NHS. This brought criticism from at least one senior Australian clinician and commentator who thought that it would be unacceptable to expect patients to take a less convenient regimen.

Linda-Gail Bekker

As always presented clearly and passionately about the current experience of HIV in Africa and was able to compare and contrast this to other global settings. She is able to mix population and locational differences and introduce a third dimension of how these interact.

Adolescents were for a long time not a priority in HIV prevention. Key affected populations, are largely characterised as being “the-non-majority population”. While recognising this, she introduced an emerged KAP in Africa and that is adolescent women.

Linda-Gail was able to focus on trends which demonstrated changes for the good. It was very interesting to see a map where Australia was pink (on a blue to red scale) for increasing or sustained new infections. While our numbers might not be big they seem to be somewhat intransigent. Many African states have seen dramatic improvements. While more developed settings seem to be finding it difficult to make changes to address persistent, comparatively low-level, new infections. Something which Fauci also recognised in the USA. It would be interesting to see Andrew Hill’s economic assessment of the cost of these different interventions.

A great opening session which augers well for the coming days.

Levinia

 

 

Hello from Glasgow. What an amazing first day we have had.

The program today was a great mix of new information and case studies.

I was surprised to start the day with a Hepatitis C session but it was really informative. 

Take Home message from this session - in the context of HIV positive individuals, it may take 12 months for the HCV antibody yest to become positive - hence if suspicious , do HCV PCR.

Ian Mc Gowan from the University of Pittsburgh discussed long acting ARVs for both treatment and prevention which will be a great advancement for those patients with adherence problems - drug and alcohol usage and mental health issues.

Currently phase 2 studies for Rilpivirine and Cabotegravir - an analogue of Dolutegravir -  a booster dose initially and then dosing every 4-8 weeks.

Also EFdA which is a long acting formulation which would last 12 months - an implanon like device.

The highlight of the day for me was Dr Anthony Fauci from the National Institute of Allergy and Infectious Diseases who delivered the Joep Lange and Jacqueline van Tongeren Memorial Lecture.

He spoke of Ending the HIV/AIDS pandemic by following the science. He spoke of the advances since the first HIV notifications in 1981 and how far we had come. South Africa are about to enter into a phase 2 trial with a vaccine!! it was incredible to reflect on how far we have come in the last 35 years but looking at the incidence around the world, how for we still have to go.

Is 90,90,90 really achievable? Some of the audience felt that it would never be achievable in their country but ....... did we ever envisage the possibility of a vaccine? We live in hope.

Andrew Hill from St Stephens AIDS Trust at the Chelsea and Westminster Hospital spoke the the difference in cost of drugs in different countries - a really contentious issue. We do not know how lucky we re in Australia to be able to treat as many patients as we want for HCV.

Looking forward to Day 2. Thank you ASHM for this amazing opportunity!

Anthony Fauci from the National Institute of Allergy and Infectious Diseases (NIAID) & National Institute of Health (NIH), Bethesda, USA, presented an excellent keynote lecture on ending the HIV/AIDS pandemic.

He started by taking us through a timeline of HIV infection. Starting in the 1980s, when the mean life expectancy of a newly diagnosed 20 year old (not on ART) was ~12 years. We followed the science through time and today, over 35 years later, the mean life expectancy of a newly diagnosed 20 year old (on ART) is ~53 years.

What we've learned since the 1980's regarding the etiology, virology, pathogenesis, treatment and prevention have given us a better understanding on how all these advances should continue to be used in conjunction in order to end the HIV/AIDS epidemic.

We've discussed treatment as prevention (TasP) and looked at a traid of pivotal ART studies regarding the treatment of individuals with HIV infection:

  • The SMART study showed that episodic ART is inferior to continuous ART
  • The HPTN 052 study showed that early ART reduces HIV transmission to uninfected sexual partners by 93%
  • The START study showed that early ART reduces serious illness or death by 57%

 

We are all aware of the continuum of care when our patients have a positive HIV test results, but we should also be very proactive in the continuum of prevention in those who test negative.

Despite our 90/90/90 targets, the numbers of newly diagnosed HIV infection have plateaued globally since 2009.

Continuing to improve access to ART and HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) could dramatically decrease HIV-related deaths and the rate of new HIV infections.

The efficacy of PrEP has been proven in multiple studies and most recently the San Francisco Strut PrEP program showed no new HIV infections in >1200 men on PrEP in nurse-lead intervention over nearly 1.5 years. There were 82 new infection at that clinic among men not enrolled in the PrEP program.

The two main remaining scientific challenges for HIV identified are:

  • Addressing HIV persistence
    • eradicate the reservoir - classic "cure"
    • control viral rebound - sustained virologic remission
  • Development of a safe and effective preventative HIV vaccine 

Towards a HIV vaccine:

  • The first signal of efficacy (31%) in a HIV vaccine clinical trail - RV144, was seen in: Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. S Rerks-Ngarm, et al. For the MOPH-TAVEG investigators. N Engl J Med 2009; 361:2209-2220. Dec 3, 2009
  • Additional work since this study has lead to a large-scale HIV vaccine trial that will launch in November 2016 in South Africa: HVTN 702 modifeid RV144 prime-boost regime
  • More work is also being done on Neutrolising Monoclonal Antibodies, discovered since 2009.

 

Conclusion:

Treatment + non-vaccine prevention + vaccine = durable end of the HIV/AIDS pandemic

 The first day of the HIV Drug Therapy conference in Glasgow today featured presentations and panel discussions of a number of complex clinical cases focussing on antiretroviral treatment choices in the context of other comorbidities, particularly Hepatitis C infection. 

 

Dr Alessia Dalla Pria from Chelsea and Westminster Hospital presented the case of a male patient with HIV-associated B cell lymphoma infiltrating the liver, complicated by HCV-related cirrhosis and acute renal insufficiency.  The timing of treatment of both the lymphoma and Hepatitis C infection was discussed, with the two conditions in this case being treated concurrently.  The take-home messages: it is important to consider not only CYP3A4 drug-drug interactions, but also P-glycoprotein P and other trans-membrane transporters in considering DDIs, as the concentration of R-CHOP chemotherapy can be increased by Hep C treatment leading to increased toxicity.  Interferon and Ribavirin are also contraindicated during cancer treatment due to overlap toxicity with chemotherapy and the unknown effects of interferon on lymphoproliferative disorders.  Protease inhibitors shouldn't be used in patients with Child-Pugh B or C decompensated cirrhosis.

 

The differences in rates of diagnosis of HIV, linkage to care, retention in care, appropriate ARV treatment and successful viral suppression (the HIV care cascade) in Italy, the USA and the UK were highlighted by Dr Cristina Mussini from the University of Modena.  The rates in the USA were surprisingly poor relative to those of Italy and the UK, with a large percentage of HIV positive people being lost to follow-up, emphasising the importance of universal health care in improving accessibility of HIV treatment and management of the HIV epidemic.  

 

In a study of the HIV care cascade among 12 infectious diseases clinics in Italy in 2013, approximately 7-9% of patients were lost in each successive column of the care cascade, prompting discussion on how retention in care can be optimised - in particular, clinic protocols for systematically monitoring retention rates and contacting patients who don’t attend planned reviews.  A study done at Chelsea and Westminster Hospital in 2011 showed that of patients presenting late with opportunistic infections, 62% had had a positive HIV test previously but had failed to be retained in care. 

 

Dr Laura Waters reported on a study conducted in the USA using point-of-care HIV tests administered in pharmacies in the community.  Of 1000 tests done, 1.5% had a positive result, at an overall cost per positive test (new diagnosis of HIV) of around $30.  This may be a potentially cost-effective approach to improving access to HIV testing if high-risk groups are targeted.

 

Linda-Gail Bekker from the Desmond Tutu HIV Centre in Cape Town talked about a study currently underway of the use of PrEP in 300 female sex workers in South Africa.  She reported that between 45 and 70% of female sex workers in the region are HIV positive, making this a particularly vulnerable group.  Elsewhere it was reported that non-oral forms of PrEP (such as injection, implant or ring, if available) would be preferred by 55% of African women due in part to the stigma associated with taking anti-retroviral medication.

 

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.

Dr Laura Waters talk on HIV treatment cascade and other HIV population prevention/treatment issues.

 

2020 goals aiming for 90% of people with HIV diagnosed/90% diagnosed on treatment/90% on treatment undetectable - corresponds to 74% of those with HIV having undetectable viral load.

  •  Currently (globally) only 32% of those with HIV are on treatment with undetectable VL.

 

June 2016 paper (Lazarus et al) on adding a “fourth 90” to the 90-90-90-90 targets; that 90% of those on ARVs with undetectable VL have good health-related quality-of-life. Especially pertinent considering incidence of co-morbidities and ageing HIV-infected population (in developed countries).

 

2016 research from Toronto (Wilton et al) on high-risk populations and perception of risk studied 420 MSM who were objectively high risk:

 

  •       68.3% didn’t perceive themselves to be at moderate to high risk
  •      23.6% unaware of PrEP
  •      40.1% unwilling to use prep
  •    47% lacked a family physician with whom they could discuss HIV issues

 

 

Survey of Glasgow2016 audience on new directions for treatment - 40% of attendees believe that non-oral ART will be first-line by 2026.

 

Transmitted drug resistance by geographical region (START trial) - Australia highest (17.5% had any transmitted drug resistance)

Talk by Professor Ian McGowan on long-acting ARVs (LAARVs).

 

-       Research from NYC (MSM) indicates high rates of willingness, and that a majority would prefer an injection.

-       Research from Africa (women) indicates that injection/implant/vaginal ring (as PrEP) would be preferred.

 

Current development of LAARVs is both for treatment and prevention.

 

Requirements for LAARVs as injection:

-       Infrequent dosing (every 2-3 months)

-       Practical injection volume (<4mL)

-       Doesn’t require cold-chain storage

 

Rilpivirine and cabotegravir most likely candidates of current generation of medications.

-       Have only been evaluated in the context of clinical trials (phase 1 and 2); adherence data likely to vary in the real world (and depending on whether being given as PrEP or treatment)

-       Tolerability good; patient satisfaction overall good

-       Efficacy signal in cabotegravir (animal studies)

-       Injection-site reactions reasonably frequent over time (highest at first injection)

-       Long-acting rilpirivine detectable in tissue (plasma/endocervical and vaginal fluid) up to >500 days (!) later – which is concerning for risk of resistance. Therefore cabotegravir more promising for use as long-acting PrEP (and phase 3 studies planned) – cabotegravir involves 4 week oral lead-in then Q8 weekly injection.

 

Novel NRTI “EFdA” also promising based on animal modelling; currently at phase 1 studies in humans. Animal models indicate that long-acting formulation could be effective up to 1yr.

 

As mentioned elsewhere – TAF silicone tubing implant and biodegradable implants both promising for use as PrEP.

 

Main challenges with LAARVs:

-       Safety (need oral lead-in)

-       Acceptability (needs real-world data)

-       Adherence

-       Resistance

-       Pharmacokinetics

-       Delivery

Amazing 1st day at this conference, enjoyed most of the sessions, very scientific and to be totally honest, some of it 'over my head'. What did I learn and want to bring back to my peers in Refugee/Sexual health?

1) the push to have more community HIV clinics, where clients can access without the stigma attached to hospital clinics.

2) some research is looking at 'inplanontype devices which leak the drug slowly over a 12 month period and could be removed if unable to tolerate.

3) some research also showed that clients would prefer to self administer injections rather than taking tablets for their illness. Clients were able to forget about their daily regime of tablet taking, were able to be more spontaneous, felt the injections were safe and the fear of needles was not a major concern.

4) Implantable PrEP (silicon tubing implant) which would have a minimum 1 year insertion and then dissolve!!

5) Lower cost of medications for the treatment of cancer, HIV & Viral Hepatitis by Andrew Hill was very interesting. He discussed the cost of drugs in reality if made in India which is far cheaper than other options. I think we should all be looking at his research/discussions and possibly buying our drugs from India which I believe is legal in Australia.

Lastly, as you know, there has been an increase in Australia in HIV cases and I wonder if we are doing enough to educate our population? Clearly not. The last speaker of the evening was Linda-Gail Becker who talked out the 'kids born after 2000' the 'i-generation' who are using technology for everything. Maybe we should be educating  this population via devices!!

If there is something you would love to know and couldn't be here, let me know and I will endeavour to find out for you. Cheers Karinne and thanks to ASHM for my scholarship.

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