• Long-acting therapies are promising alternatives to the daily oral medication paradigm

    Dr. Gandhi identified current issues in the state of antiretroviral therapy for HIV including cost, weight gain, daily oral dosing, and pregnancy. He reviewed the current landscape of long-acting drugs including the two-monthly long-acting cabotegravir/rilpivrine antiretroviral combination delivered via intramuscular injection (ATLAS, ATLAS-2M, FLAIR), as well as islatravir which is being studied as an implant and broadly neutralising antibodies as infusions. He insightfully compared these developments with long-acting contraceptive and depot antipsychotics in patients who struggle with daily oral dosing.

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  • Virtually there

    The experience of a virtual conference (live!!) was odd. The main down side was the lack of interaction and ability to dicsuss sessions and data, ask questions and gerenally get a feel of the general response to the speakers. The tech side was fine but many of the speakers were really fast- mainly as they were presenting to microphones rather than audiences.

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  • Weighing in on integrase-inhibitors

    A report back on Michell Mugglin's and Sebastian Verboeket's session Weight-gain under integrase-inhibitors: Is this real?

    I must say, I was very surprised to find it was standing-room only at this session on INSTI effects on body weight. This more recent observation, that integrase-inhibitors, particularly the second generation drugs (dolutegravir, bictegravir), are associated with increases in body weight (Sax et al, Clin Infect Dis. 2019 Oct 14), has sparked a flurry of interest in this area.

    These findings have left us with more questions than answers. How is body weight distributed? What mechanisms are involved? Is this a ‘true’ side-effect, or simply the effect of a ‘return to health’ phenomenon?

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  • CHEMSEX - not that different in Australia

    A report back on Magdalena Rosinka and Tristian Barber's session CHEMSEX: East and West.

    On the first morning of EACS 19, as part of the EACS pre-educational course, I attended a fascinating presentation on Chemsex: East and West, which also discussed HIV prevalence and PrEP. The session was in two parts and Magdalena Rosinka presented on Eastern Europe, and Tristan Barber on Western Europe.

    The prevalence of chemsex and the drugs used varied some-what between the two areas, but were consistently higher in large urban centers, which is not that different from Australia. The main difference compared to Australia is that we don’t have the high prevalence of mephedrone, as they do in Europe, which is probably a blessing.

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  • Insomnia

    A report back on Nina Vora's and Hugh Selsick's session Zzzzzzzzz: Sleep issues beyond efavirenz. Nina Vora presented an excellent clinical case of a newly diagnosed client who had continual issues with insomnia. The client, despite a couple of changes with antiretroviral therapy, still continued to have problems. The client was also very insistent that it was the onset of ART that had started his insomnia.

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  • Integrated Clinical Models of Care in People with HIV

    The occurrence of some malignancies (ano-genital cancer and Hodgkin Lymphoma) in people with HIV (PWHIV) are increasing and cancers comprise of one third of Non-AIDS events in PWHIV. Approximately, 18% of cancer cases are caused by infection and 12% are caused by one of seven human tumour viruses (Hepatitis B and C, HTLV, Merkel Cell Polyomavirus, HPV, EBV, Kaposi Sarcoma Herpesvirus). Overall, HIV positive people with cancer have worse survival.

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  • Reflections on the HIV/AIDS Opening Plenary: HIV Criminalisation

    A report back on Edwin Bernard presentation More than science: Ensuring we leave no-one behind as we strive to end the epidemic. 

    During the HIV/AIDS Conference Opening Plenary session Edwin Bernard spoke about the ongoing impacts HIV criminalisation, stigma and discrimination are having on our efforts to end the HIV epidemic.

    Edwin provided us with an update on the important work of the HIV Justice Network and presented video footage from the 2016 “Beyond Blame” conference. The HIV Justice Network is a global information and advocacy hub for individuals and organisations working to end the inappropriate use of the criminal law to regulate and punish people living with HIV. The stories presented during this presentation were incredibly powerful, providing insight into the lives of people living with HIV (PLHIV) who have been criminalised and the injustices that they have faced. This had a profound impact on me, as a healthcare professional, and reminded me of the important role we all have in working towards the decriminalisation of HIV. Author bio: Lucy Thallon is the Clinical Nurse Consultant for the HIV Response Team at Cairns Sexual Health Service. She is passionate about sexual and reproductive health and rights, with her work focusing on marginalised populations affected by HIV. ​

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  • Equity of access…enough talk, time for action

    A report back on Nick Medland, Christopher Bourne, Gemma Crawford, Roanna Lobo's presentation Mobility/Migration. 

    Thursday morning and it is the last day of the HIV conference. The Symposium on Mobility/Migration is of crucial importance as we see the increasing divergence in HIV notifications between Australian born MSM and their overseas born peers. Nick Medland started the conversation with sobering data for Southeast Asian-born people living in Australia. Their HIV diagnosis and care cascade last year predicted 27% of HIV in this community remains undiagnosed. They face significant challenges accessing biomedical HIV prevention that has shown to be so successful for Australian born MSM. The sophistication required to navigate the layers of HIV prevention and the language we use to describe it can be an obstacle for those newly arrived. Their perception and understanding of risk, HIV health literacy, language and culture, as well as potentially discriminating immigration policies are all barriers to access. Treatment access can also be difficult and there was considerable discussion during question time about treatment access for people living with HIV who are inegligible for medicare. Nick didn’t beat around the bush in his conclusions stating that “failing to provide adequate HIV prevention and treatment to people living in Australia in intolerable, unethical and irresponsible”, and that “elimination of HIV transmission through biomedical prevention will fail while there are unequal coverage of ART and PrEP”. 

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  • Syphylaxis?

    A report back on Basil Donovan and Christopher Fairley's Debate: Doxycycline should be provided for syphilis prophylaxis in those at high risk. 

    As the Sexual Health conference came to a close, it was time for some light-hearted debate between Basil Donovan and Kit Fairley on the use of doxycycline as syphilis prophylaxis. The session Chair, Lewis Marshall, introduced the debate as being akin to all good duels, such as that between David and Goliath or Buzz Lightyear and Woody! Hang on…. aren’t Buzz and Woody on the same team? And in fact, this was a good predictor of what was to come. Basil was tasked with the affirmative and set about laying the ground work for the potential to all but eliminate the syphilis epidemic in 10 years if we could convince about half of all men who have sex with more than 20 male partners a year to take daily prophylaxis. It is our moral obligation in fact to provide such chemoprophylaxis if one exists. Basil downplayed any potential for side effects and antimicrobial resistance (reassuring us that all the antimicrobial resistance to doxycycline has already occurred – hardly reassuring) and added in the benefit that we could also potentially prevent chlamydia and gonorrhoea. “The community want it”, Basil says and seeing as it works so well for HIV, chemoprophylaxis for syphilis is the logical next step. 

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  • Time for women?

    A report back on Deb Bateson, Moira Wilson, Rachael Dunn and Diane Lloyd's presentation HIV&AIDS symposium 19, HIV and women across the reproductive lifespan and beyond

    Wednesday afternoon saw the first session specifically for women living with HIV. The small meeting room was overflowing with every seat taken with not even standing room left. Diane Lloyd spoke of women’s invisibility during her 33 years of living with HIV in Australia and her point wasn’t lost on the audience. Deborah Bateson opened the session with a discussion of contraception choices for women living with HIV. While all methods are potentially suitable, interactions with enzyme inducing ARVs can cause issues with oral contraceptive pills and may lead to increased method failure. This can also cause a problem with levonorgestrel emergency contraception requiring a double dose. There was eager anticipation of the results of the ECHO trial from South Africa released in June this year which didn’t find any increase in HIV acquisition for women with the use of injectable progesterone contracepton despite years of concern.   

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