Matthew Shields

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.

EACS Guidelnes 2015 Session

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I am quite of fan of the EACS guidelines particularly for co-morbidities and on  Friday they had a session detailing what's new in version 8.0 October 2015

1. ART
presented by Jose Gatell
The Europeans are now on page with everyone else with treatment recommended for all persons with established HIV infection regardless of CD4 count, the exception being elite controllers. This brings all 4 sets of guidelines into agreeance: DHHS, IAS and WHO (see table below)
The next slide is the greatly revised table of what to start with. Key features are:
13 regimens downsized to 6 (the DHHS guidelines have just 5, choosing to omit TDF/FTC/RPV whereas the EACS retains)
Increasing number of INSTI based regimens
Rentention of one each of PI and NNRTI based regimens
2. PrEP
also presented by Jose Gatel
A whole new chapter in the guidelines and the only set of guidelines internationally to recommend "on demand" PrEP based on IPERGAY. CDC guidelines continue to support daily PrEP.  Ongoing concerns about on demand PrEP include reduced efficacy in MSM who may not be having sex as often as the men in IPERGAY or who may not be as good as tailoring Intermittent PrEP usage to perceived risk of sexual events as the men in IPERGAY. You can't deny the overall efficacy however. Will intermittent PrEP's inclusion in guidelines influence your practice?
3. HCV/HBV Co-infection
Presented by Jurgen Rockstroh
Highly revised guidelines on which HCV patients to treat with DAAs. See the photo below. This table is adapted from the EASL guidelines drawn up in May and includes a footnote on who should be given priority for treatment independent of liver fibrosis. I think it is very forward thinking as it includes those with debilitating fatigue, extra hepatic manifestations such as cryoglobulinaemia and those at risk of HCV transmission including high risk MSMs. It is interesting how we are beginning to apply TasP principles to HCV. Applying TasP principles to the co-infection epidemic in MSM is not unfounded because it is concentrated and networked but it is probably unfounded in monoinfection with only an estimated 40% people diagnosed in most countries. 
Finally the table below is a useful clinical tool for monitoring acute HCV infection. Spontaneous clearance is indicated by viral decay in log at certain time points. It still  lists IFN/RBV as treatment for acute infection only because we have not yet consolidated the evidence base for this with DAAs. That is about to change however with 3 datasets of DAA treatment in acute HCV almost ready. 
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