ASHM Report Back
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.
The IAS AIDS2016 Conference in Durban, officially opened Monday night local time, however multiple pre-conference meetings had already taken place in the days running up that, including the first MSM Global Forum to be held in Africa; the 1st IAS HIV Cure Symposium, TB, HIV/HCV co-infection, paediatric HIV sessions as well as funder meetings, and political activism, along with cultural and community events in the Global Village. It is 16 years since the conference was held in South Africa, in Durban and the current meeting's theme is "Access Equity/Rights Now" – a central demand is the need for world leaders to meet global goals they need to continue to support HIV treatment and prevention and stick to their funding commitments and goals as well as a call to combat inappropriate criminalisation of HIV transmission (and recognising the current evidence base of very low HIV transmission risks in a treatment era) – something ASHM is working on through a Consensus Statement with expert stakeholders nationally.
See highlights from The Daily Review of Pre-Conference activity here: http://bit.ly/2asdU8N
See highlights from The Daily Review of the launch on Monday 18 July 2016 here: http://bit.ly/29TH1B8
See highlights from The Daily Review of Tuesday 19 July 2016 here: www.aidsmap.com/page/3072007
MSM Global Forum points out critical issues
Chris Beyrer, President of the IAS opened the MSM Global Forum pre-conference day meeting, pointing out that the recent UNAIDS High Level Meeting on HIV/AIDS struggled to keep key populations on the agenda including MSM, and stigma remains a critical issue intersecting with very low funding (2% of global funding which is out of proportion to the burden of new infections among MSM), violence and criminalisation. An interesting angle taken by the Forum was considering the national economic costs of homophobia, based on a premise that if political leaders and decision makers do not listen to rights based arguments then the ‘dollar value’ impact of the consequences of homophobia on their respective government wallets might work better. Legal reform indicators need also to be included in UNAIDS global indicators.
"Know your epidemic means know your HIVDR"
At a well-attended pre-conference meeting, a WHO organised session on HIV Drug Resistance found speakers addressing an inherent potential paradox of a universal access or ‘Treat All’ global response and indeed PrEP scale up and the increased risk therefore of HIV drug resistance (HIVDR). This session therefore focused on how to prevent the emergence and transmission of HIV DR and consequent risk of treatment failure, increase in drug costs, higher treatment complexity and lowered durability of 1st line regimens (i.e. if people need to switch to more expensive 2nd or even 3rd line regimens due to DR). Fast tracking of global treatment goals need to include the issue of HIV DR risk and this should be an integral part of delivering quality HIV services and be part of routine program management in terms of VL suppression across all the UNAIDS 90-90-90 goals. Presentations focused on strengthening surveillance with the inclusion of a new zero draft WHO Global Action Plan on Early Warning Indicators (EWI) for HIV DR. This plan is intended to complement national HIV DR surveillance through for example indicators of possible emergence of DR such as monitoring ART prescribing practices, loss to follow-up at 12 months, retention on ART at 12 months, on-time pill pick up, on time appointment keeping, drug stock outs and their relation to VL suppression. VL monitoring is obviously also critically needed (as a proxy for possible patient HIV DR) but still unavailable in too many country contexts. Clinic level data from 55 countries have indicated high levels of appropriate prescribing but sub-optimal levels of loss to follow-up at 12 months, retention at 12 months on time ARV drug pick up and ARV stock outs – which could indicate emergence of HIV DR.
WHO seeks online public consultation on Global Action Plan on HIV Drug Resistance
WHO is consulting with global and regional stakeholders to inform the Global Action Plan on HIV DR – of note to the region is a WHO Western Pacific/South-east Asia regional consultation in Bangkok, August 8th – 12th, 2016 with a plan finalised by end 2016 and full launch in early 2017.
The documentation link is here: www.who.int/hiv/drugresistance/hivdr-action-plan-2016-2021/en/
Sign up for HIVDR updates here: www.surveymonkey.com/r/LX28W5Z
Tonight was a very moving opening ceremony for opening of the 21 st International AIDS conference. Many speakers made reference to the World AIDS meeting in 2000 and the great achievements of the last 16 years. From almost no access to treatment in Africa then, now more than 12 million people are receiving ART.
Today is also the birthday of Nelson Mandela. At the 2000 meeting he famously said "AIDS is caused by HIV". Leading up to the 2000 conference and at the opening the then president of South Africa, Thabo Mbeki, denied the role of HIV as the cause of AIDS.
I attended the 2000 meeting so it is exciting to be back in Durban. I am very much looking forward to reporting on new developments in HIV and HIV/HCV co-infection.
But I will leave it to Charlize Theron. Talking about a cure for HIV she said ".... we have to stop meeting like this..."
It's my first time attending an International AIDS Conference and my first time blogging for ASHM. Over the past 18months I've been working as an HIV s100 prescriber, but it seems like there is a lifetime of learning to catch up on.
I'm told by my colleagues that the AIDS Conference held in Durban 16 years ago was a turning point in our understanding and treatment of HIV/AIDS, but it's hard to believe that back in 2000 'AIDS denialism' was still a thing.
Nelson Mandela made his famous speech at the AIDS2000 closing ceremony, but Charlize Theron took centre stage at this year's opening ceremony, stating "HIV isn't just transmitted by sex. It's transmitted by sexism, racism, poverty and homophobia. And if we're going to end AIDS we have to cure the disease within our own hearts and within our own minds first". From what I understand Charlize is more intent on challenging psychological barriers rather than curing endocarditis or encephalitis - however I've noticed many people at the conference are very passionate about treating Tuberculosis.
Charlize Theron made an impassioned plea to end HIV by the year 2030, suggesting that we should only have another seven International AIDS Conferences before the next generation finishes off HIV for good. She proposed that the next generation should be called "Gen End It" and a new hashtag was born.
Get ready to see #genendit in your social media feeds over the next few years.
This WHO consultation followed on immediately from the CDC. This was one of the data collection workshops aimed at feeding into the development of the new WHO resistance testing guidelines. I was the only person in the audience from South East Asia and the Western Pacific. But a survey can be completed on line Insert website.
What was important here is the trade-off between affordable therapy for most people versus switching (and abandoning 1st line therapy). Willem Venter, from South Africa, cautioned against switching, and introduced the practicality that this would not be affordable, if 85% of people were benefiting from that therapy. Jonathan Shapiro questioned the 15% versus 85% assumption about resistance, and suggested there might need to be more consideration of this.
I raised the issue that there was no-one in the audience from ESA and the Pacific, including Australia. The consultation is open online and I was told consultation would come from the WPRO and SEPRO offices.