Day 4 started with a session on PrEP in High Income Settings with a panel from USA and Europe and Jean -Michel Molina from France where PrEP has already been implemented.

It was interesting to listen to the discussion - everyone was in agreement of the value of PrEP and no-one had concerns about resistance or side-effects. There was debate about daily PrEP or on demand PrEP and how the choice will improve uptake and adherence.

There was concern about the cost of PrEP and who will access it and Keith Rawlings from Gilead in USA gave an excellent presentation on the demographics of the HIV positive population in the USA and the demographics of the PrEP accessing population - those that need it most do not access it.

There was also an interesting presentation about delivery modes - tablets, long acting injectables or slow release preparations - a Dapivirine vaginal ring.

Should treatment for Rectal Gonorrhoea and Chlamydia include PrEP??

The most surprising statement that was made today was in the last session of the day by Dong Wie from Nanjing China. In China, they only have access to six antiretroviral drugs. I found that difficult to believe but made me appreciate the range of drugs that we have in Australia.

Day 3 started with an excellent Symposium " Helping the Patients Stay on Course"

The session started with the importance of adherence to treatment and the barriers to this - the most common one being depression. 45% of cases of depression do unrecognised in HIV clinical care so if we are to look at the 90 90 90 target we need to make sure that we address the Mental Health needs of our patients to start to attempt to address this but more important is the fourth 90 - the quality of life.

Moises Agosto is a PLWHIV who is a Public health Physician and he gave a very personal account of the patient aspect and the doctor aspect. He also addressed the ageing of the HIV epidemic and the impact of comorbidities becoming more important after the age of 50 years.

The second session was  "Comorbidities and HIV management"and looked at the needs of HIV patients today and 10 years ago - particularly cognitive function and neuropsychiatric events - in particular looking at discontinuation of treatment due to adverse drug interactions and side effects.

During the lunch break there was a very interesting session on APPS and New technology in the Management of HIV infection and using social media to get the messages out to the target audience.

There was also discussion about medical APPS and privacy issues - should we be worried about confidentiality?? Should the medical APPS be developed by clinicians or IT gurus? 

Andri Rauch presented a very interesting session on HCV therapies and the remaining challenges - the take home message for me was that an SVR reduces the risk of HCC but does not eliminate it - do not forget the HCV treatment successes because they may not be a long term success.

Day 2 was amazing

The day started with the Lock lecture delivered by Julio Montaner from British Columbia. The overwhelming messages were:

Treatment as Prevention to prevent morbidity and mortality

ART is 100 % effective in preventing vertical transmission

While the end of the pandemic may be in sight, we need to be vigilant as there are problematic clusters of HIV emerging all the time and there is potential for the fire to be rekindled.

Jens Lundgren from Copenhagen provided a convincing argument for early vs deferred treatment but warned that CVS risk protection was not convincing with early treatment.

Cheryl Johnson from WHO Geneva provided a very insightful talk on the barriers to HIV testing and it is very apparent that this is the area that we need to improve upon if we are to meet the 90 90 90 target. The identification of the positive patients is the most important part of the cascade and we are still failing to identify them.

There was some controversy over HIV self testing and "At Home" STI screening but it was a suggestion to be able to test more people and reducing the stigma of having to go to a test centre and have the test. Also need to look at the accessibility of testing to patients - hours of opening and outreach centres.

Also discussed was differential ART delivery and the number of times per year that a stable patient needed to see a doctor.

There were a few Interactive cases which were very practical and could have been adapted to suit the practice of most of the clinicians in the audience.

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!