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.
Day 2 - Population stats, treatment and convenient care
Today began with an interesting talk by Prof. Julio Montaner. He spoke about HIV treatment as prevention (TasP) – I found it interesting that based on a couple of models (from Hlabisa, Africa and BC, Canada), for every 1% increased coverage (with ARV and undetectable VL), one can estimate a 1% decrease in HIV incidence.
Prof Montaner also presented research on the HIV strains found in British Columbia. Phylogenetic studies of the strains found show that, even with high rates of diagnosis, treatment and viral suppression (Vancouver on-track to reaching 90/90/90 goals by 2020), significant clusters of new infections still continue to occur, and that investigation, prevention and treatment strategies must focus on these clusters. Contact and partner tracing were strongly emphasised.
Jens Lundgren spoke next regarding the START (early ART) study update.
- Hazard ratio of 0.43 of serious AIDS/non-AIDS events in early treatment arm (compared with delayed treatment) – so unblinded early.
- Significantly decreased rates of OI in early treatment arm.
- Cancer occurrence had a 64% risk reduction in early treatment arm.
- No evidence of a change in hazard ratio for cardiovascular disease; no evidence of a change in FEV1 between arms; no evidene of different in neuropsych testing results.
- Bone mineral density testing showed total spine BMD decreased in immediate vs delayed ART – clinical implications unclear.
Chloe Orkin spoke about a couple of studies involving TAF – study 1089 involved switching from TDF to TAF in those virologically suppressed. n=663; all initially on TDF/FTC + 3rd agent. Half had TDF switched to TAF.
- No difference in rate of discontinuation or adverse events between arms.
- No difference in efficacy at 96 weeks – TAF/FTC noninferior.
- Average EGFR and BMD improved in TAF arm.
- Slight increase in LDL/TC in TAF arm, but no change in total cholesterol:HDL ratio.
Finally Patrick Sullivan spoke about the importance of convenience in improving HIV care. He discussed strategies including:
- Integration into routine clinical encounters
- Self-service options
- Home delivery of investigation/treatment/PrEP
- Reminder systems for routine screening.
His team has developed a mobile app called Healthmindr (still under trial and only US-based I think) that helps with behaviour screening, PrEP assessment and advice and reminders about STI screens.
They’re also trialling STI testing and PrEP at home – involves initiation and follow-up to three months in the clinic, then visits and monitoring after that can be done at home (a kit is mailed and self-collected swabs/FCU/blood tests, as well as survey). Acceptability has been high and sample quality adequate.