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.

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The next session I attended was an industry sponsored session on Maturing Patients, Maturing therapy: Multidisciplinary management in HIV.  The session on management of Cancer in HIV by Christine Katlama (Professor of Infectious Diseases and Head of the HIV Clinical Research Unit
Department of Infectious Diseases France) & Jean-Philippe Spano (Professor in Medical Oncology, in the Department of Medical Oncology of Pr. David Khayat at the Pitié-Salpétrière Hospital in Paris, France) highlighted the increasing medical issue of people living with HIV and cancer diagnoses.  Amongst some interesting case studies, the main points discussed were that viral-induced cancers are more prevalent in HIV positive patients compared with HIV negative patients, the impact of smoking is excessive and needs addressing and multidisciplinary team approaches are extremely important to maximise the therapeutic management of HIV patients with cancers.

 

They demonstrated a great example of this collaboration in the form of a 6 weekly web-conference that they have set up in Paris between Oncologists, HIV specialists, pharmacists and immunologists where they discuss cases and ensure any possible treatment interactions between ART and chemotherapy are evaluated by experts as well as consideration of the possible benefits of new immune therapies. Whilst perhaps not the direct purpose of the session I found the take home message for me was thinking about the importance of cancer screening and prevention in the comorbidity assessments of stable HIV positive clients that nurses are increasingly involved with.  Smoking cessation should be continually encouraged and revisited at every possible occasion in a supportive way as unsurprisingly tobacco smoking is attributable to many of the cancers diagnosed.

 

 

Day 1 @ #EACS2017 did not disappoint!  Much like colourful displays of gelato in Milan’s exquisite restaurants the conference proved to be a veritable feast of tasty information and similar to the difficulty in picking your ice cream flavour so was the conundrum of choosing what session to attend!

 

 

 

To begin the day I started at the WAVE (Women Against Viruses in Europe) Workshop.  I listened to a very empowering speech given by Justyna Kopeć a Polish lady diagnosed with HIV 20 years ago who’s talk was entitled “The longest relationship I ever had”.  She highlighted at least 3 occasions when her diagnosis was missed between 1993 and 1997 which included participating in an anonymous HIV testing at university in which she did not collect her result, vising the gynaecologist with several recurrent vaginal infections and a GP visit for continued weight loss without dieting.  She talked about her journey of hope as new drugs came on the market at the time of her diagnoses, fear of dying, fear of treatment, fear of a daily routine, and trust in her doctors, trust in her family and friends and trust in science and in patient centred care.  She also talked about the changes over time for young women newly diagnosed in today's era in terms of pregnancy and living long enough to watch those children grow.  This session was a great reminder that HIV can affect anyone.  As a nurse I often see clients for HPV wart treatments and other symptoms such as vaginal candida and it reminded me of the importance of thinking of underlying reasons for persisting infections, accurate history taking (as people are transient between services and indeed countries) and not to overlook HIV as a possibility for someone who is not in the forefront of my mind as “high risk”.  Justyna closed with the statement “HIV testing should be a standard procedure among ALL sexually active people”.

 

Please also see the post from Emma Clements

Posted by on in Testing and Treatment

Sophie Flavell and John White spoke about STI testing and screening.

 

Important take home messages for me in this session were:

 

- don’t forget that for MSM with high risk behaviour Hep C is sexually transmitted ie make sure you include it in STI screen in high risk populations

- consider using doxycycline 200mg as a stat dose as PEP for chlamydia and syphilis (70% reduction in infections)

- pooled testing (3 samples in one pot)for chlamydia/gonorrhoea NAAT is currently not funded but saves money and will form part of the future in STI testing

Day 1, post number two.

This afternoon I attended a round table discussion on PrEP, after the opening ceremony. It seemed everyone in the conference was there as the room was packed! 

 

 

Rebecca Houghton will be blogging about this in more detail but I wanted to touch on the excellent presentation by Dr Emma Devitt from Dean Street Clinic in London as this was another analysis of a model of care, but of a single service. It is well known that the Dean Street model of care is progressive and hearing her discuss the way the service has actively adapted to the needs of the community in it's location, design, and flexible staffing is a lesson we should absorb. The clinic's redesign in 2014 to include an express service running 6 days a week is of note as it takes full advantage of many technologies that are available to us; videos explaining self-specimen collection that play within the mirror in the bathroom; and their GeneXpert has been calibrated to bypass a middle man and text clients their results directly. Inspiring stuff! She highlighted that express models still require medical staff on site to support nurses and health care assistants, and also discussed how the delivery of PrEP is evolving in their clinic with nurse prescribing. 

Hello from the 16th European AIDS conference in Milan. 

 

This morning I attended a very interesting workshop organised by WAVE, Women against Viruses in Europe, where numerous aspects of caring for women with HIV were presented and discussed.

 

The session started with a very powerful and insightful presentation by Justyna Kopec who has just celebrated her 20th anniversary of living with HIV. She discussed her journey to diagnosis and disclosed a number of lost opportunities to an earlier diagnosis (eg testing and then never returning for results) and highlighted that staff at her 'clinic' were integral to her feeling supported throughout her life living with HIV. This was a really excellent presentation to kick off with to remind us all to keep patients are at the centre of their care.  (see Catherine Orr’s notes from this session here)

 

Following was an analysis of the models of care for HIV positive Women in Europe split into West, Central and Eastern areas by Dr Annette Haberl from Germany, Dr Cristiana Oprea from Romania and Dr Inga Iatysheva from Russia, respectively. There is a huge amount of detail surrounding the variations in HIV care in each country and all face similar challenges in varying degrees i.e. coordination of allied specialist services such as gynaecology, psychology and social supports, or lack of integrated services, particularly in less economically enabled countries; barriers to accessing care surrounding child care responsibilities; lack of gender autonomy; fear of stigma. 

 

 

I noted that nurse led models of care for women living with HIV did not come up in discussion from any of the 3 speakers; the analysis may have not drilled down to this level but nurse led models of care could be useful in resource poor environments particularly. Additionally, further research as a high priority area was raised, and 2 speakers suggested that WAVE could be the right platform to assist coordinate research, exchange experience and create expert advisory groups. 

 

At the first day of the European AIDS Conference 2017, Sharon Walmsley (Senior Scientist at Toronto General Hospital Research Institute) spoke at the Women Against Viruses in Europe (WAVE) forum.  

When considering ART in women it is important to remember the following

  • drug trials rarely include significant numbers of women
  • Consider whether woman is planning pregnancy (remember safety of ART in pregnancy is generally based on expert opinion not on evidence)
  • Consider drug interactions with contraception
  • Stribild and Genvoya not recommended in pregnancy as elvitegravir and cobicistat do not cross placenta so baby is not getting adequate levels
  • Consider co-morbidity in the older woman especially around menopause and cardiovascular risk
  • HIV and/or ARTs seem to cause higher rates of early menopause
  • Women living with HIV have higher rates of CVD AND women living with HIV have higher rates of osteoporotic fractures
  • Therefore consider change of ART at menopause
  • Women represent >50% of people living with HIV however studies of drugs for HIV rarely include significant numbers of women. 

 

 More to come...

Tagged in: EACS 2017
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