2018 HIV Drug Therapy

A report on Andrew Hill's presentation "Minimum prices of generic Hepatitis C direct acting antivirals fall below US$50"

Andrew outlines an alternative cost strategy for making the elimination of Hepatitis C (HCV) affordable. This talk complements the previous one by Margaret Hellard.

A report on Margaret Hellard's "Eliminating Hepatitis C by 2030: A public health perspective"

Margaret made a compelling case for a more concerted effort to be made worldwide for Hepatitis C ( HCV) to be eliminated. HCV is responsible for a similar number of deaths worldwide as HIV and TB, and more than are due to malaria. Yet, HCV is remarkable for now having a highly effective cure using Direct Acting Antivirals (DAAs), that can be achieved in 3 months and with minimal side effects.

A report on Simon Rackstraw’s presentation “Factors associated with HIV-associated neurocognitive disorder in an unselected cohort in East and South London: the HAND study” 

This presentation demonstrated the findings from a prospective study in which 786 people living with HIV (PLWH) aged >18 were recruited from four HIV clinics across East and South London to determine: 

a) the extent of neurocognitive impairment (NCI) within the cohort, and
b) to establish correlation with HIV-related factors and medical co-morbidities.  

A report on: Karoline Aebi-Popp’s presentation “What Women Want: Pharmacokinetic studies in women and its impact on clinic practice”

Most women around the world living with HIV are of reproductive age. Worldwide there are high rates of unplanned pregnancies in HIV-positive women and unsurprisingly even higher rates among women not on ARVs. This presentation elucidated that the promotion of effective and safe contraception is critical, and that a choice needs to be offered to women, where possible. 

This presentation also highlighted a great resource for practitioners to use: The Liverpool HIV Drug Interactions website which has a section on Contraception with a colour-coded table to guide safe contraceptive choice.

A report on Sheena McCormack's presentation "PrEP: What's happening in Europe and the world in general"

This presentation outlined the current status of PrEP uptake around the world. It touched on some of the challenges and outlined some of the anticipated new medications and new modes of delivery of PrEP.

The overwhelming message is that PrEP using TDF/FTC either daily or on demand is effective in averting new HIV infections ( PREVENIR study 85 HIV infections averted; EPIC N.S.W. 31.5% decline in recent infections compared with previous year, 25% reduction attributed to  PrEP; Soho London clinic 80% decline in HIV cases since 2015).

A report on Jean-Michel Molina's presentation "STIs among MSM: New challenges in prevention, diagnosis and treatment"

The success of Antiretroviral therapy (ART) in the treatment and prevention of HIV has resulted in a marked reduction in the perception of risk of HIV, AIDS and death, termed “risk compensation”, and has resulted in reduced condom use. From 2013 to 2017 community level change in consistent condom use with casual partners fell from 46% to 31%. Over the same period, STI rates in 12 months increased from 17% to 31%.  This was accompanied by increased HIV, and presumably other STI testing. Of note, over the same period both those with HIV being treated with ART increased to 94% and with those with an undetectable viral load also increased to 94% (Holt M. et al Lancet HIV 2018).