Blogs2 Blog Archive

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?

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.

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.

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.

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. ​

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”. 

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. 

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.   

A reporty back on David Lewis and Catriona Bradshaw's presentation Clinical Management and Therapeutics – MGEN Symposium.

After a morning of antimicrobial resistant gonorrhoea, it was time to turn our attention to antimicrobial resistant Mycoplasma genitalium (MG).  Prof. David Lewis set the scene by outlining the prevalence (about 1-2%) and clinical role of MG and perhaps it was more a case of what we don’t know than what we do.  While the association between MG and non-gonococcal urethritis in men is clear, it is less certain when it comes to proctitis, epididymitis and balanoposthitis. 

A report back on David Speers, Deborah Williamson, Cameron Buckley, David Lewis and Jana Sisnowski prese

A/Prof. David Speers kicked off the discussion of antimicrobial resistant gonorrhoea this morning as he delivered the Dr Morris Gollow’s lecture during the opening plenary.  Gonorrhoea has been steadily developing resistance to whichever antibiotic has been used to treat it since the sulfa based drugs in 1937.  David described the multiple mechanisms that Neisseria gonorrhoeae uses to incorporate antimicrobial resistance and while it raises serious concerns about our ability to treat this infection in the future, one can’t help but admire its innovation and resilience!  ​