• What can we (in Australia) learn from HIV & Migration in Europe?

    A report on Julia Del Amo's presentation "HIV & Migration: a Renewed Challenge"

    Since 2015, Europe has been in the grip of a “Migrant Crisis”1 , shifting the population landscape in some countries and a change in the political climate.

    As Julia Del Amo from the National Center for Epidemiology, Institute of Health Carlos III, Madrid explained in her session “HIV & Migration: a Renewed Challenge”, the UN definition of a migrant is incredibly broad2 and this is reflected in the challenges that are faced domestically, politically and economically when considering these groups. She delivered an enlightening presentation on Wednesday morning at the Glasgow 2018 conference outlining patterns of HIV such as country of origin for newly acquired HIV cases & HIV positive migrants in Europe; acquisition method and trends in HIV positive migrants from specific regional ‘hotspots’. 

    Of course, the situations in Europe and Australia greatly differ. With strict border controls and compulsory HIV testing when applying for permanent visas, it could be argued that this data does not apply to us – and certainly Australia has some of the lowest rates of HIV positive migration in the world. But there would be few Clinicians among us who do not have patients who have migrated either legally or illegally to this country and there were many elements of this presentation that could be translated into greater awareness and care for this cohort.

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  • Approaches towards a cure for HIV

    A report on Sarah Fidler's presentation "Approaches towards a cure for HIV"

    This presentation, on the third day of the conference was one of the best attended - with an entirely packed auditorium. As a Clinical Trials Coordinator, the question of a cure comes up on a regular basis in my work. Even though we now have U=U, and with most patients having a very small burden, there are still those who yearn to be pill and disease free.

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  • Drug-Drug Interactions

    A report on Catia Marzolini's presentation "The top 10 DDIs in day-to-day clinical management of HIV"

    In this session Catia Marzolini from the Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland gave a presentation titled ‘The top 10 DDIs in day-to-day clinical management of HIV’.

    It is well known that HIV-infected patients may be at risk of a clinically significant drug-drug interaction (DDI), since antiretroviral drugs are recognised to be amongst the therapeutic agents with the highest potential for DDIs. In this session, the drug-drug interaction potential of antiretroviral drugs was discussed with interactions occurring at drug metabolism, drug excretion or drug absorption. The common mechanisms identified for these interactions were inhibition or induction of drug metabolising enzymes or drug transporters as well as chelation with polyvalent actions or pH-dependent changes in drug absorption. The antiretroviral agents were categorised into either victim drugs or perpetrator drugs, with some agents acting as both victims and perpetrators.

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  • Global Antiretroviral Guidelines - Recommended Antiretroviral Regimens Updated

    A report on Chloe Orkin's presentation in the session "Challenging Cases in HIV Prevention and Management in collaboration with the International Antiviral Society-USA (IAS-USA)"

    A session regarding initiating antiretroviral therapy (ART) was presented by Chloe Orkin from Barts Health NHS Trust and Queen Mary University of London, London, UK. Chloe Orkin is also the current Chair of the British HIV Association (BHIVA). The presentation was titled ‘Case 2: ART – initiating treatment’ in a section of the conference called ‘Challenging Cases in HIV Prevention and Management’ in collaboration with the International Antiviral Society-USA (IAS-USA).

    In this presentation Chloe Orkin presented 3 cases of first line ART – What to start, Rapid ART and ART in pregnancy. For this post I have elected to concentrate on the ‘What to Start’ section of this presentation.

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  • New Antiretroviral Drugs - 2018

    A report on Alexandra Calmy's presentation "New ARV drugs and strategies"

    In this session Alexandra Calmy from the HIV/AIDS Unit, Geneva University Hospitals, Geneva, Switzerland delivered a presentation titled ‘New ARV drugs and strategies’ in the final Late Breakers/Hot Topics section of the Conference.

    Alexandra Calmy covered a significant amount of information in this session, commencing with drugs in the pipeline. She discussed the issue that the global need for better HIV treatment means that data to inform their use in all settings are needed. Here she made reference to the gaps in data for the use of dolutegravir in certain clinical situations.

    Another issue presented was the two safety alerts related to the use of antiretrovirals during pregnancy in 2018. The first being the risk of birth defects in babies born to women taking dolutegravir, and the second the new contraindication against using darunavir/cobicistat during pregnancy due to the significantly reduced plasma levels of darunavir and cobicistat during the second and third trimesters of pregnancy.

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  • Mycoplasma Genitalium – what we can learn from smaller studies in the absence of bigger ones….

    A report on Rosie Latimer’s presentation “Clinical Features of Mycoplasma Genitalium Associated Pelvic Inflammatory Disease and Response to Moxifloxacin: A Case Series” as well as Ruthy McIver’s presentation "Men who have sex with men with Mycoplasma genitalium are more likely to have macrolide resistant strains than men with only female partners: a prospective study”   

     

    “Clinical Features of Mycoplasma genitalium associated Pelvic Inflammatory Disease and response to Moxifloxacin: a Case Series”

    As a sexual health doctor in the era of Mycoplasma genitalium’s (MG) fast increasing resistance to available antibiotics and a paucity of antibiotic choice, I frequently face conundrums around the treatment of patients with MG.  Previous meta-analyses have shown MG has a role in Pelvis Inflammatory Disease (PID) but there is little evidence on the characteristics of MG-associated PID. The findings of this study specifically comparing chlamydial and MGPID therefore interested me. 

    The aims of this first study were 2-fold: (1) to describe the clinical characteristics of MG PID and to determine how they differ from those associated with Chlamydial PID (CT-PID). (2) To determine the proportion of women cured of MG-PID following 14 days of Moxifloxacin, either by NAAT test or clinical cure. 

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  • Fantastic First Ever Australian Hepatitis C in General Practice Forum held in Adelaide 2018

    It is now nearly three months since the first national 'Treating Hepatitis C in General Practice Forum' was held in Adelaide. I was lucky enough to be a member of the organising committee which included GPs from across Australia. 

     On reflection, highlights from the day-long event included: 

    • Having 50 GPs from across Australia in a room, with a mix of experience from novice to experienced HCV prescriber, to share information and experiences. It was great having a few HCV specialists in the room providing the latest information and evidence. The feedback from the day was so positive that we are hoping it will become an annual event.  

    • The important role GPs can play in the whole person viral hepatitis disease management, from detecting the 30-40,000 people living with chronic HCV not yet diagnosed, to one stop shop GP HCV assessment and DAA treatment for most, and the important long term role monitoring of those with cirrhosis. 

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  • Applying the 8 Ways to Increase Hepatitis C Treatment in my Practice

    I am a general practice registrar in Launceston, Tasmania. Attending the Treating Hepatitis C in General Practice Forum was a great educational experience for me. I was able to appreciate the practical intricacies of treating Hepatitis C in the community, and learn from passionate general practitioners from various parts of Australia about treating Hepatitis C.  

    I learnt the most from Dr Nada Andric’s presentation about the 8 ways to increase HCV treatment in general practice. She illustrated the 8 steps to take, including audit, training, bloods, GPMP, connect, pharmacy and follow up. They were practical methods and easily translated to my practice in Launceston. Since attending the Forum I have prepared a plan according to the 8 steps: 

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  • Changing our approach to service provision for Culturally and Linguistically Diverse Groups

    A report on the Opening Plenary, delivered by Associate Professor Leonie Pihama, Professor Matthew Golden, and Associate Professor Carmen Logie.

    In this plenary, three presenters from three countries discussed how to make approaches to HIV and other STI programs workk in specific populations.

    Key learnings:

    Whilst didactic approaches to populations with good levels of literacy might be effective in certain circumstances, many other groups require different approaches. Hard to reach populations require innovation and dedication and may be far more labour intensive to ensure enrolment in, and maintainance of, programs. Programs that have failed to attract certain clients will continue to fail to attract these clients. What is needed is a different program and not a repetition of the existing program. 

    Developing understandings of diverse cultural groups can ensure that Practitioners can gain trust with their patients, which can help empower them to make decisions that impact their health positively. Aspects to be considered range from communication methods, including availability to care in their own language and the physical materials used, to practical logistic considerations such as provision of transport to access testing or treatment. Services may need to be free or nearly free and there must be consideration about longer-term sustainability.  

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  • The power of education in ensuring equitable access

    A report on Dr Richelle Douglas’ presentation “Abortion: empowering the clinical workforce” 

    This symposium explored equity of access to contraception and abortion, with Dr Douglas providing a clear voice in not only explaining what some of the issues are, but also what can be done to overcome them.  She discussed access and uptake of abortion globally, attitudes to abortion, implications of training and how we can begin to improve.  My main takeaway was that access to abortion training is limited, which has serious implications for our patients. 

    Half of all pregnancies are unintended and 1 in 4 women have a termination of pregnancy (TOP) at some time in their lives.  Unintended pregnancies have a higher risk of maternal morbidity and mortality. Therefore improving access to contraception and abortion can improve maternal mortality rates.  In general, these facts are not debated, but what is less straightforward is how to overcome this problem. In Australia there are limited public facilities that provide abortion training and services.  This results in massive inequity of access, with the most vulnerable people in our community often unable to pay for and access a TOP. 

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