Blogs2 July 2018

At the risk of repeating what has already been summarised by my colleagues, I feel a sense of obligation to report back on the data presented regarding on-demand PrEP in the MSM community due to the widespread interest and the fact that with PrEP being available on the PBS, many GPs will likely be fielding questions about this dosing option, which has been in the ASHM PrEP guidelines as an option in the MSM community albeit with only early evidence.

Pre-exposure prophylaxis (PrEP) was a major theme at this conference with a number of excellent papers and reviews presented.

Of particular relevance to the Australian context was the paper by Jean-Michel Molina, Incidence of HIV-infection in the ANRS Prevenir Study in the Paris Region with Daily or On Demand PrEP with TDF/FTC. 

In a powerful presentation, Dr David Malebranche gave his talk titled “Making the Treatment Cascade work in Vulnerable and Key populations” in the plenary session on Day 4 of the conference. Watch the video here. 

Prior to Dr Malebranche’s presentation, there was a video-link from another location in which the Co-chair of the conference Professor Peter Reiss, was attempting to light a cauldron with the Positive Flame (in honour of being 90 years since the Olympic Games in Amsterdam and also having the AIDS Conference in Amsterdam). However AIDS activists from key populations stormed the room and prevented Prof Weiss from lighting the conference through protest (he eventually did after some time).

Effectiveness of hepatitis A virus (HAV) vaccination among people living with HIV during a hepatitis A outbreak in Taiwan, 2015-2017

Outbreaks of hepatitis A virus (HAV) infection have re-emerged among men who have sex with men (MSM) across the Asia-Pacific region, the United States, and several European countries since 2015. In Taiwan the suboptimal response to HAV vaccine among MSM living with HIV raises serious concerns about the personal-level and population-level effectiveness of HAV vaccination. This pattern of under vaccination to HAV among MSM has also been seen in the outbreak of hepatitis A in the key population in Australia that warranted State governments offering funded vaccination to curb this outbreak.

Given the evident ongoing interest in PrEP at AIDS2018, this session was surprisingly undersubscribed. Not only did the presenters review the current PrEP data from clinical trials and real-life implementation, but also data related to novel and next-generation PrEP and antibody mediated HIV prevention.

This session covered the various aspects African and European countries encountered during their PrEP implementation and its uptake. What lessons were learned that helps guided future rollout of the program to various key populations who are at greater risk of HIV acquisition then the general population. I have only selected a few from the many presentations from this session to provide an overview of what was covered.

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:

• TAF 25mg without cobisistat (TAF/FTC/RPV 25/200/25) n =31
• TAF 10mgwith cobisistat (TAF/FTC/ECG/COBI 10/200/150/150) n= 27

Intensive steady state PK profiles were obtained at steady state during 2^nd trimester, 3^rd trimester and 6-12 weeks post-partum. Both maternal plasma and cord blood samples were collected at delivery.

Given our aging population and the significant advances in management of HIV, I was incredibly interested to attend this session regarding the management of issues arising in aging of PLWHIV. Although interesting, this session did not focus on clinical care of the aged, but instead on those who will be living with chronic HIV in the future, and health system structure and program development in preparedness for the management of a wide spectrum of non-communicable diseases that we are witnessing in PLWHIV.

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.