This entertaining session presented a number of varying cases to highlight the promises PrEP may bring but also the pitfalls.

It emphasized the importance of "hearing the patient", as to their psychological and sexual needs.

In South Africa, Dr Abdool Karim expressed that women need PrEP type product that they can initiate themselves , independent from their partners knowledge , as a study of seroconversion rates still revealed 9.1%seroconversion in young women. She also reported an association between HPV acquisition and HIV acquisition.

Dr Raphael Landovitz from L.A. Introduced a new term "the dribble effect", which refers to lowering of serum levels of Truvada as some doses are missed , but those lower drug doses may still give some protection. It is still to be determined what the ideal treatment protocol is and also what are the lower serum levels that still offer some protection, before development of resistance may occur.

So far  Truvada toxicity has been minimal with most serum creatinines recovering  to normal.

a major issue will be cost as it is not yet funded in Australia.

 who will be keen to take it and how often it will need to be taken was explored in different scenarios which included the discordant MSM couple, the monogamous African woman, and the bipolar personality.

Dr  Landovitz stated the numbers were too low in the Ipergay trial to determine the efficacy of that regime.

we have lots to learn in the era of PrEP but it appears to be very promising as another way to prevent  further HIV seroconversions

 It is known that combined  Antiretroviral therapy(cART) before 6 weeks of age results in low levels of HIV .

If treatment starts before 1 year of age, there is a median of 4 copies at 10 yrs of age.

Treatment within first 48 hrs(& first 4 days of life), most will clear the virus before 4 months. Most of the virus is in transient memory cells, rather than central memory cells. The Missisipi baby was infected in utero but treatment was initiated within 31 hrs and discontinued at 18 mths. This baby remained in remission for 28 mths off cART.

Very early cART alters HIV persistence in children. It limits pro viral and replication competent reservoirs.

In adults, we are still determining what undetectable HIV (when being treated with ART) really means., and how early is the ideal time to start treatment.

In HIV infection, there is a massive expansion of HIV in lymphoid tissue but with treatment it is undetectable in the bloodstream. There may be decreased intracellulardrug concentration in lymphatic tissue And this may be the site of clones that expand when cART is stopped or if there is poor adherence to ART medications for whatever reason

No impact of HIV on HEPC treatment outcome

95-97% cure rates even in co-infected

Improvement in quality of life occurs v. Quickly with new oral medIcations due to suppression of the Hep C virus.

If there is cirrhosis of the liver, treat for 24 weeks. De compensated cirrhosis may be reversible, but not always.

In Australia, HIV/HCV co infected numbers approx 2,500-3,000

Most cells infected with HIV are CD4's- what makes these cells persist long term.?

CD4cells have attributes of expanded cellular clones. The larger the cluster the older it is.

In HIV controllers, most are restricted to a particular tissue site.

Infected cells can traffick out into the blood and expand.

Can infected CD4cells capable of producing virus clonally expand in Vivo?

Where does virus replication occur in HIV controllers?Blood and lymphoid tissue are v. Different reservoirs.Rare sequences survived to traffick out of blood and into lymphoid tissue.

Are there any sequence similarities between lymph nodes at different sites?

The reservoir contains an archive of viral evolution