This presentation by Doris Chebo looks at the risks of the change of thinking towards pushing for treatment as soon as possible after HIV diagnosis from the point of view of current Victorian baseline HIV drug resistance profiles .

The aim of earliest possible treatment is to limit risks of disease progression and reduce HIV transmission, both very worthwhile ideals .

Levels of transmitted drug resistance mutations were reviewed looking at standard drug resistance genotyping in 1356 samples from 2011 to 2015. These included new 

As expected, protease and integrate inhibitor regimes had the lowest level of potential resistance (<1%). Potential resistance to NNRTIs was higher at 4.6%.

This brings up the question of whether to start people on treatment before genotype profiles are available particularly where access is more difficult.

The study was pretty reassuring for us, in that these seem like only  small number of patients had significant drug resistance to our usual ASHM recommended first line treatment regimes.

Several sessions of ASHM have compared Viral Load (VL) when patients are retained in care, vs those who don't. This session examines the results of the IEDEA Collaboration on VL in adults and children.

The IEDEA is an International Epidemiological Data Base, which gathers data around the world, grouped into 7 regions.

35,561 adults and 2,601 children (81% perinatal infected) from four regions were examined. They found 90% of adults had VL suppression at 3 years. Unfortunately the children didn't fare so well, with only 70-80% having VL suppression at the same time. Both of these data sets, were people who were retained in care. When people who were lost to care were added to the figures, the rates of VL suppression was much lower.

Conclusion: Adult patients retained in care have good VL suppression. Each region has different rates of VL suppression. The W.H.O. aim for 90/90/90 in children will be difficult as adherence is more challenging in this group.

41 sexual health clinics across Australia took part.

Treatment uptake 63% in 2007, 79% in 2015.

Significant reduction in viral load over the same time period for those on treatment.

Female, injecting drug user, indigenous groups were twice as likely to have a detectable viral load on treatment.

James McMahon  presented  a study comparing HIV load and CD4 count for people in regular care versus those   with unknown outcomes.

He estimated the study covered 80% of HIV positive patients in Victoria over 3 years in 4 sites.

It involved clinics checked their records to look for transfer of care, deaths and returnees to care. 

Patients who did not return for at least one more VL  within a 9 month period were then contacted.

Retention rates for patients were very good at 92%. 

The study found that those who had unknown outcomes,transfered their care/returned to care or who had irregular VL testing had higher VL and were at risk of worse clinical outcomes and onward transmission.

They found that as a result of doing the study there were improvement in clinic systems to improve retention and keep patients engaged in care This was an unexpected positive outcome from this study.

Looking at the strength of ACCESS to look at the cascades of care.

National collaboration.

Automated data extractions.

Laboratory network captures 80% of people living with HIV.

De-identified viral load records.

Viral suppression taken to be < 200.

Mean age of patients was around 40 years.

Trends over time saw an increase from 71% to 87.5% of patients with suppressed viral load.

Those under 40 years were less likely to achieve viral suppression.

Similar outcomes in terms of gender.

These data reflect those engaged in care.