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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Posted by on in Public Health and Prevention

Challenging start to the day with two interesting trainee case presentations with Sian Goddard presenting two linked cases of syphilis in a mother and daughter and a reminder to screen at risk immigrants; and Vinita Rane presenting a case of HSV penile ulceration in a HIV positive patient, with other confounding STIs, that was successfully treated with imiquimod. 

Congratulations to both on these excellent presentations.

Tagged in: HIVAIDS2015

We had a wonderful symposium tonight where key HIV clinicians, researchers and community members came together and oozed optimism for the 'PrEP program'.  And I deliberately emphasize that PrEP is not just about taking a pill but a program i.e. users take Truvada and be engaged with their health provider in getting regular HIV/STI and kidney function testing (3 monthly).

There is no doubt about PrEP's effectiveness with the latest studies (PROUD and IPERGAY) showing 86% effectiveness in reducing HIV seroconversion.  But if PrEP was used daily, effectiveness approached 100%.  

It was interesting to see data from San Francisco (Street Survey) showing that 63% of PrEP users reported condomless anal intercourse with 6 or more partners in the last 6 months. This is important because PrEP is being used by those at highest risk for HIV (or in the words of Prof Bob Grant - those who are "popular and affectionate"). There is ongoing debate about who should access PrEP.  Should it be only dispensed to those at highest risk for HIV as defined by the current Australian PrEP guidelines? This remains a contentious point as a modelling study by David Wilson from the Kirby has shown that PrEP was cost-effective only if we dispensed it to those at highest risk. However there was a strong sentiment in the room to allow PrEP to be freely available to whoever wanted it.  

Even if we agreed that anyone should be able to choose to be on PrEP, access is still an issue in Australia.  Although we are starting to see many clinics throughout Australia prescribing PrEP, access to Truvada can only be obtained by importing the drugs from overseas through online pharmacies like www.aids-drugs-online.com or www.alldaychemist.com  This is approximated to cost ~$88/month.  This may still put PrEP out of reach of those who are socioeconomically disadvantaged.  So it was heartening to hear from A/Prof Darren Russell that the HIV Foundation in Queensland is launching a program to allow access to PrEP to those who are financially disadvantaged.

Another interesting point from the panel of speakers was that PrEP had multiple fringe benefits including empowerment, and healing of prior trauma and fear.  This was emphasized particularly from current PrEP users.

It is difficult to determine how many people in Australia are currently using PrEP but we may still be at the stage where PrEP users are the innovators or early adopters.  But as the community continues to grow in their experience of using PrEP, we may see this becoming an important part of the armamentarium of HIV biomedical prevention.
 

Tagged in: HIVAIDS2015
PrEP Community Forum (aka Are you PrEPing for the future?)

What a privilege to attend this forum which featured amongst others Dr Robert Grant, named one of Time magazine’s most influential people in 2012 for being the father of “treatment as prevention.” Dr Grant highlighted the observation that PrEP use in San Francisco had reached a positive tipping point in the last few years, with increasing use of PrEP. How have they come to this point?

It's been driven by:
1) PrEP research and demonstration projects being run in San Francisco
2) The FDA approval for Truvada use in PrEP, and
3) Word of mouth and the use of social media

Dr Grant also reiterated that by using an intention to treat analysis, PrEP is efficacious - the analysis shows that in order to prevent 1 HIV infection, 13 to 18 people were required to be treated. The recommendation for PrEP is for daily dosing although the data shows that if users were taking PrEP 4 times or more per week, the benefits were maximised. Daily dosing provides for a high level of protection and is forgiving of the occasional missed dose. The exciting takeaway message I took was that currently, there are Phase 2 Trials in long acting injectable PrEP, which may come to fruition around 2020.

Dr Darren Russell spoke about PrEP in Australia and the current 'lay of the land'. Importantly, he announced that the HIV Foundation Queensland was in planning to roll out an affordable access program for low-income individuals via the Foundation, to counter the social and ethical inequities of access to PrEP in Queensland. Dr Russell also 'hypothesised' that Truvada for PrEP may obtain TGA approval in the first quarter of 2016 and hopefully PBS approval in the latter half of 2017 (all going well). Watch this space!

Most importantly, this forum highlighted the social science and personal impacts of PrEP - it's ability to mitigate the fear of HIV, the empowerment of users, the circumvention of condom difficulties to prevent HIV infection. We heard both from Chris Williams an early adopter and PrEP advocate and Dr Fiona Bisshop, a PrEP prescriber at Holdsworth House Medical Brisbane.

The final word? If you are not PrEP'd for the future, you better get with the program.

Posted by on in Uncategorised Posts

Hello Everyone

Cant wait to get to Brisbane on Tuesday and join at the ASHM Conference Wednesday

See You Then

Jeffrey

Tagged in: HIVAIDS2015

Posted by on in Public Health and Prevention

We kickstarted the conference with an update on potential vaccines for STIs by Prof Ian Frazer, the co-founder of the HPV vaccine.  He gave a 'passing grade' on his STD vaccine score card for vaccines against Hepatitis B and HPV vaccinations but major innovation is needed for vaccines against treponema pallidum, neisseria gonorrhea, mycoplasma genitalium, trichomonas vaginalis and H. ducreyi.  There was some sad news and exciting news.

The sad news was that there was a marked disparity between rollout of HPV vaccine programs and cervical cancer prevalence.  So, the countries that have the highest rates of cervical cancer (mostly on the African continent and South Asia) have no HPV vaccine programs currently.

The exciting part of his talk was around his work on a vaccine against Herpes Simplex Virus.  Whilst a previous paper in NEJM 2012 Jan 5:366 (1):34-43 showed some protection in HSV 1-2 uninfected women against HSV-1,  the protection conferred was not significant enough to warrant further development of that form of herpes vaccine.  However, Ian Frazer's group is now looking at a herpes vaccine using newer technologies (now in phase 2 trials) that may show greater promise.  Watch this space!

 

Jason Ong.

Tagged in: HIVAIDS2015

ASHM is pleased to launch our recently updated General Practitioners and HIV resource. You can download the resourc… https://t.co/UVP72mrTeP

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