It’s the final day of the AIDS 2018 conference, and while attending an address by Bill Clinton I was thinking about the pertinent issues highlighted over the last few days.
For me, a recurring concern throughout the conference was the inequitable division of resources, treatment and prevention globally and the ongoing struggle of marginalised groups to access HIV care and prevention. Most namely, in my opinion young African women – with new infection rates rising in this population. At home we seem to be winning… with treatment as prevention and access to oral PrEP in Australia (but also the UK and North America) already having an incredible impact on reducing new infections, reducing stigma and increasing empowerment. Access and uptake of prevention in Africa remains still very poor. Extraordinary new long-lasting more discrete prevention devices and strategies are being developed and trialled yet we must also ensure that expense and access are not prohibitive to countries where they can make the most impact.
TAF pharmacokinetics with and without cobisistat in pregnancy
The impact of physiological changes during pregnancy on the PK of TAF is yet to be studied in pregnant women. The IMPAACT P1026s focused on pharmacokinetics of TAF with and without cobicistat during pregnancy.
Pregnant women in the USA were enrolled if they were receiving as part of clinical care:
Intensive steady state PK profiles were obtained at steady state during 2nd trimester, 3rd trimester and 6-12 weeks post-partum. Both maternal plasma and cord blood samples were collected at delivery.
Of perhaps more relevance to the Australian setting was the brief overview of upcoming novel drug delivery devices for ART, presented next by Kimberly Scarsi, University of Nebraska. She selected 3 new delivery devices to discuss; long-acting injectables using nanomedicines, subcutaneous implantable devices, and long-acting oral products.
Two thought provoking research posters looking at PrEP in transgender women (TGW) were presented on Tuesday, primarily considering the potential drug-drug interaction with feminising hormones. Both reported studies were very small and the clinical implications uncertain, but highlighted that need for further study in this area.
This well attended and eagerly awaited session regarding the recent safety concerns with dolutegravir (DTG) in pregnancy, was fantastic. We heard from an expert panel of inspiring female researchers, regulators and bioethicists to guide our thoughts.
In a nutshell, the Tsepamo study in Botswana (more detail below) has identified an increased safety signal of neural tube defects (NTD) in women taking DTG at time of conception. Neural tube closure occurs at around 28 days gestation, so it is early exposure at conception that seems to be the concern.
Well it’s the opening day of the AIDS 2018 conference today and after resurrecting my childhood cycling skills and navigating this beautiful city I attended a symposium on HIV prevention in women.
Globally, young and adolescent females remain at very high risk of HIV infection, with new infections in the age group 15-24 being 44% higher than men. In Africa, in this age group we see >7000 new HIV infections every week.
