2018 HIV Drug Therapy PrEP

A report on Julia Del Amo’s presentation “HIV and Migration: a renewed challenge”

Julia del Amo challenged our assumptions about HIV and migrants, with particular focus on Europe. Some migrants arrive to their destination country already living with HIV, either acquiring it in their port of origin or during their journey. However, the number of men who acquire HIV after they migrate is startling. 

There are steadily increasing numbers of MSM who are diagnosed within the first year of living in their destination country (up 58% since 2007), while people who are heterosexual and newly diagnosed is declining (down 36% from 2007).  Moreover, in migrants from sub-Saharan Africa who are found to have HIV a year after arrival, approximately 72% of MSM and 50% of heterosexual migrants acquired HIV post-migration. This is determined using a validated method of estimating acquisition. 

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.

A report on Victoria Pilkington's "Meta-analysis of the risk of Grade 3/4 or serious adverse events in 12 randomised trials of PrEP (n=15,678)"

Since its presention at HIV Glasgow, there has been a lot of coverage of the meta-analysis of PrEP presented by Dr Victoria Pilkington of Imperial College, London (e.g. ow.ly/ALap30mppiv). The story has been re-told through a variety of medical and non-medical media emphasising the bottom line: TDF/FTC as PrEP is safe. As we know, there are an increasing number of PrEP prescriptions in North America, Australia, and Western Europe with the global estimated number of people taking PrEP to be around 300 000.

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).