• Novel treatment strategies for LMIC

    A report back on Pedro Cahn's session - Novel treatment strategies

    Pedro Cahn presented on what treatments were used by low and middle income countries (LMIC) and what they could look forward to in the future. The WHO recommendation for these countries is the use of TDF + 3TC + DTG as first line, except for women of child-bearing age where EFV was the preferred third agent. EFV and PI based regimens are now second/third line treatments. As not INSTIs are available in these countries, he also went through the currently available INSTIs. The new NNRTI was also discussed as well as other pipeline treatments (injectables, implants, monoclonal antibodies)

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  • Self testing?

    A report back on Siroat Jittjang's session - HIV testing? The answer is YES stupid!

    This session focused on the willingness to pay and acceptability of self-testing in Thailand.

    Mr. Jittjang gave 2 presentations about his Thai study on self-testing. They looked at assisted and unassisted self-testing, depending on patient preference. The majority of participants chose to have assisted testing, where it was done in front of a tester using the oraquick oral HIV test kit by MSM and transgender women. It was very well accepted by both groups (>80%) and most preferred the assisted self testing. 34- 38% were first time testers. One of the negatives were the number of participants who did not link to follow up services with either a reactive or irregular test result. The acceptable pricing for these tests were between USD8-9.50.

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  • HIV cure/remission

    A report back on Denise Hsu's, James McMahon's and Eugene Kroon's session - Progress in HIV Cure/Elimination​

    Denise Hsu introduced the topic with how the HIV reservoir can be measured in a number of ways including single copy assay showing the majority of individuals on ART with undetectable viral load on conventional assays will unsurprisingly retain detectable VL on single copy assay- the median level being 3.1 copies/ml. This most likely represents virus production from integrated provirus in reservoirs such as LN and the CNS as ART intensification does not reduce the number.

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  • Current knowledge in viral hepatitis

    A report back on Peter Revill's session - Hepatitis B therapy pipeline for cure 

    40 % of all liver cancers are caused by Hepatitis B and this risk not eliminated by treatment. Worldwide there are 880,000 deaths annually from Hepatitis B. One barrier to achieving cure is the viral reservoir is complex consisting of covalently closed circular DNA in the nucleus, integrated DNA and cytoplasmic phases. Current treatments (Tenofovir,Entecavir) work in the cytoplasm but not in the nucleus. This cccDNA  is retained even when “cured” and can reactivate  in the future with eg chemotherapy .HBSAg loss +/- Hep B SAb associated with undetectable serum DNA occurs at a rate of 1-2 % per year either spontaneously or on current treatments.

     

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  • PrEPare for Resistance… But Don’t Panic

    A report back on Donn Colby's session Starting PrEP During Acute HIV Infection: What is the Risk for Antiretroviral Drug Resistance?

    Donn Colby talked about the people who were inadvertently prescribed PrEP during acute HIV infection. The cohort of patients he examined were mainly MSM and male, with a median age of 32 years. Fortunately, only a small proportion of those who were prescribed PrEP through the Thai Red Cross Anonymous Clinic were later found to have acute HIV infection (1 in 350). The majority were diagnosed using qualitative HIV RNA, while the remainder were diagnosed by reactive HIV serology at the 1-month visit.

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  • PrEP – It’s time to let go

    A report back on Heather-Marie Schmidt's session Demedicalization of PrEP

    Heather-Marie discussed the importance of PrEP demedicalization and explored various possible strategies that can be implemented in order to improve PrEP uptake and adherence as well as to improve efficiency in health care delivery. She discussed a number of models, including nurse-led, pharmacist-led and key population led PrEP services, which have already demonstrated success in various clinics around the world.  

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  • Point of care testing for supporting the delivery of PrEP

    A report back on Tsz Ho Kwan's session Practical perspective of the use of point of care testing for supporting the delivery of HIV pre-exposure prophylaxis

    This was one of a series of fascinating presentations to a packed seminar room on recent abstracts and publications in the field of PrEP; our subject matter having a specific focus on the practical considerations and implications for clinicians and patients when choosing how and crucially, when to initiate therapy in order to increase coverage and effective use.

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  • PrEP services for transgender women in Bangkok, Thailand

    A report back on Rena Janamnuaysook's session Demographic characteristics and risk behaviors of transgender women using free versus fee-based pre-exposure prophylaxis (PrEP) services in Bangkok, Thailand.

    This was one of no less than three different sessions presented by Rena Janamnuaysook, a transgender woman (TGW) from Thailand.The study presented that a subsidized low cost ($30) PrEP was not a barrier to uptake of PrEP amongst TGW unable to access either limited free PrEP provision or full cost PrEP, and could be a mechanism for upscaling the program in Thailand.

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  • New options and opportunities in PrEP

    (A report back on Kavita Misra's session - New options and opportunities in PrEP: Impact of PrEP on drug resistance and acute HIV infection, New York City 2015-2017)

    Data on PrEP and associated resistance comes from safety and efficacy studies.  Mathematical modelling has suggested that any contribution from PrEP to resistance mutations would be very small and lower than if HIV infections were not averted. Concerns relate to starting PrEP during seroconversion and acquiring HIV and continuing the two drug regimen. 

     

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  • Treatment of Acute HCV Advocated

    (A report back on Sanjay Bhagani's session - Dynamics of Acute HCV in Western Europe​)

    Sanjay Bhagani talked about the status of acute HCV in Western Europe: compliance with the Global Health Sector Strategy (GHSS) call for the elimination of viral hepatitis as a public health threat by 2030, and the WHO reports on the significant obstacles to that strategy which include underdiagnosis and poor uptake of treatment in those diagnosed.

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