Ivette Aguirre

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.

Ivette Aguirre

Ivette Aguirre

Ivette is the Senior Clinical Pharmacist at Melbourne Sexual Health Centre (Alfred Health). She has an interest in Infectious Diseases/HIV and is in the process of completing a Master of Clinical Pharmacy involving a project looking at the impact of a Pharmacist Review at Annual Health Checks in patients taking combination antiretroviral therapy.


I attended the talk by Dr Janine Trevillyan titled: Management guidelines for HIV-related Co-morbidities result in increased screening but no change in Primary Prevention Implementation.

Janine described an audit conducted at Alfred Health, Melbourne comparing compliance with local recommendations/guidelines for screening and management of cardiovascular risk factors before and after release of the guidelines.

The audit showed that compliance rates for sticking to guidelines for statin use pre and post intervention were similar and there were no changes in patients receiving a statin pre and post intervention.

Although routine blood pressure monitoring increased from 65% pre intervention to 88% post intervention, there was no change in antihypertensive use and no observed improvement in systolic blood pressure post intervention.

One interesting finding of the audit was that renal function was borderline (eGFR 60-90mL/min) in 51% of patients. Janine mentioned that this will be something that will be followed up as the implications of these findings are unclear and it will be interesting to see where the renal function of these patients is at in a few years.

Overall, the audit found that implementation of recommendations/guidelines can increase screening rates for cardiovascular risk factors but this did not translate into improved implementation of primary prevention therapies. Janine mentioned that a change in the model of HIV care provision may be needed.

These findings are important to me as a pharmacist involved in the care of patients at an ambulatory HIV clinic. We have recently implemented a pharmacist review at annual health checks for patients taking combination antiretroviral therapy (cART) in my clinic. See poster number 12. Impact of a Pharmacist review during annual health checks in patients taking combination antiretroviral therapy.

A pharmacist review during annual health checks may help to identify patients not meeting the recommended cardiovascular risk factor targets, bring these to the attention of the doctor and assist with their management.





Tagged in: HIVAIDS2015

I attended the talk by Prof Sharon Lewin this afternoon titled ‘HIV cure research: current strategies and challenges’

Sharon started off by saying that sustained remission off ART is achievable. Some examples of this are the Visconti cohort and the Mississippi baby.

Early ART has a greater impact in limiting persistence of the HIV reservoir than later treatment (as found by Ananworanich and Chomont , Curr Opin HIV AIDS 2015). However, post treatment control is a rarity following ART in acute HIV infection and biomarkers to predict cure/remission are required (e.g. in the Swiss HIV cohort study, HIV DNA predicted time to rebound).

Sharon touched on latency reversing agents now in clinical trials e.g. HDAC inhibitors , TLR agonists, activators of NF-kB and others such as disulfiram.

Sharon said that activation of latent HIV was possible in vivo with HDAC inhibitors, disulfiram and TLR7 agoinsts but there is a need for more potent, less toxic and more specific agents.

Combination of agents (e.g. HDAC inhibitors and smac mimetics) as well as modulating immunity via vaccination or immune checkpoint inhibition are also in the pipeline and gene therapy is also an avenue to be explored.

After this talk I felt very inspired about the work Sharon and other researchers searching for a HIV cure are doing!








Tagged in: HIVAIDS2015

I attended the panel discussion titled ‘Find Me, Treat me, PrEP me, Heal me’ this afternoon.

The panel members were:

  • Prof Robert Grant,
  • Prof Mike Cohen,
  • Prof  Brian Gazzard,
  • A/Prof Edwina Wright,
  • Dr Mark Bloch,
  • Nicholas Parkhill,
  • Prof Sharon Lewin,
  • Nick Holas
  • Simon Ruth

Some interesting discussion evolved around PrEP, including the recent evidence of decreased condom use, seen at the three month follow up of VicPrEP participants (presented by John de Wit today).

Prof Mike Cohen posed the question of whether reduced condom use, leading to increased rates of STIs (which may increase the risk of getting HIV due to genital inflammation) may reduce the effectiveness of PrEP.

Prof Robert Grant pointed out that participants of recent studies such as the PROUD and iPrEx OLE studies, had high rates of STIs and PrEP was still effective in these cohorts.

One interesting point made by Dr Mark Bloch was that the patients receiving PrEP are followed up every three months for PrEP scripts. This may facilitate adherence to the recommended three monthly STI screen.

Lastly, there was discussion about when newer PrEP agents will become available. Prof Robert Grant advised that a long-acting injectable PrEP agent is just completing Phase 2 clinical trials.

Overall, an entertaining session with some food for thought.

Tagged in: HIVAIDS2015
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