Dr Beng Eu
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.
AIDS2016 Prep abstracts part 1
several prep presentations on Tuesday covering different aspects of prep.
Brocca-Cofano presented a study about using maraviroc on infant macaques as prep. The conclusion was that it offered no protection from SIV in infant macaques. This may be different in human populations.
Gulick then presented a phase II study on maraviroc tolerability in US women. There were 188 women in the study, 160 completed. This was a four arm double blind study comparing maraviroc, maraviroc + TDF , maraviroc + FTC , and TDF + FTC . This was a purely safety and tolerability study over 48 weeks and there was shown to be no difference between the four arms.
McGowan presented a study about the persistence of Rilpivirine after a single long acting injection. N=36, they compared plasma and genital fluid and rectal fluid and compared either single dose, 600 or 1200mg vs 1200 every two months. In 7/7 of the participants who had 1200mg im single dose, there was Rilpivirine present in their genital fluid and plasma after 18 months. This raises issues about he use of this as prep due to concerns about development of resistance due to this long residual level of Rilpivirine .
Grant presented a study about the benefits of prep relative to drug resistance. They showed that across all prep studies, the risk of drug resistance was very low 0.05% risk. Most of the resistance occurred in people who were HIV infected at entry into the trial. They concluded that the benefit of prep far outweighed the low risk of drug resistance. As this occurred mainly at the start of prep, it was important to exclude anyone who might have and acute vital illness from starting prep to ensure that it was not a HIV infection. It was also suggested that it might be important to do HIV Ag testing or dna before commencing prep.
Brown presented an interesting study about the use of dapavirine vaginal rings from the aspire study. The level of drug level in the ring after use gave an idea about adherence levels. After some stratification, they found that in the moderate to high adherence women, the risk reduction improved from 27% to 56-75% risk reduction.
hosek presented data about the safety of prep in 15-17 yo msm in the US. The numbers were small -60 due to recruitemnt and consent issues but the conclusion was that it was are to use with no real differences. There is the bone data presented in the past that still needs clarification.
Rawlings presented data on prep use in the US between 2013-2015. This data was collected from prescription data with PEP and treatment prescriptions excluded. Almost 80,000 people used prep in this period, with a significant increase in men using prep in the last two years. The study also looked at seroconversion rates across multiple prep studies. They had about 8,500 participants and there was a seroconversion rate of 1.03% in men, 0.25% in women.
The theme of access equality rights now is palpable. There is a mood of activism to overcome these barriers in HIV . Quite exciting to be around!
Thanks for this PrEP post
Thanks Beng for this update- very interesting! Especially about recent increased uptake in the US and the lower seroconversion rates in women.