Download New Developments in HIV

New Developments in HIV
Kerri Howley
Coordinator – The Green Room
[email protected]
Current Victorian statistics





As of July 2009 3,500 Victorians are living with HIV
Over 60% aged between 30-49
Demographics of transmission largely unchanged
80% are taking medication for HIV
There has been a 50% improvement in immune
function since 1998
www.vicaids.com.au
www.dhs.vic.gov.au
www.abs.gov.au
Changes to HIV treatment





Start earlier – 350 or above?
New drugs = 5 classes
New Ist line treatments = 1 to 2
tablets daily
Treatment is a life time commitment
= no treatment breaks
HIV genotyping is a standard
practice for all preparing to start
and in those preparing to change
medication
Babies and HIV -Chronic Viral Illness Program
RWH






For all HIV positive partners – effective, timely &
appropriate HIV treatment prior to insemination
For all men it involves separation of sperm from
semen
For HIV positive men it involves sperm ‘washing’
For all couples it involves artificial insemination,
fertility investigations, counseling, regular HIV
testing prior, during and after insemination
Sperm washing reduces the risk of HIV
transmission to less than 1in 2000 per treatment
Cost is incurred for the insemination only
Super infection of HIV








When a HIV positive person gets a second strain of HIV
(i.e.. Genetically different from 1st)
Rare: may cause re-occurance of HIV illness, may
mean that treatment options are reduced, if 2nd virus
takes over & is resistant
Smith et al in 2004 – in HAART naïve newly diagnosed,
5% acquired 2nd infection with in 6-12 months, ‘rare’ in
those on HAART
2 viruses co-exist, it is not recombination
Risk is related to unprotected sex, and amount of
activity in early and established phases of HIV disease
Screening; re-screen HIV genotype for all unexpected
viral load increases
www.aidsmap.com
www.cdc.gov
HIV transmission risk issues

Swiss Study 2008
‘People who have been taking treatment for at least 6
months, take correct treatment, do not have STIs are never
infectious to their monogamous heterosexual partner’

Fox et. al 2009 – a study of 30 sero-discordant
(mostly gay) couples having unprotected sex for 2
or more years
“A blanket healthcare message of safe sex seems inappropriate
for all HIV sero-discordant couples,” comment the
investigators, “provision of an open discussion of risk and
identification of barriers to condom use may be more
meaningful than promoting a 100% condom approach.”

Nicopoullous JDM et al.2009 –Sperm washing
study
10% of men with undetectable viral loads had ‘significant’
amounts of virus in their semen
www.aidsmap.com
www.cdc.gov
Anal cancer and HIV













3rd most common malignancy in HIV
59 times more likely to be at risk than the rest of the
community
1;1000 people with displasia will develop anal cancer
200-300;1000 will have displasia; significance
unknown
Risks; smoking, immuno-deficiency, anal sex
Like cervical HPV 16 & 18 are more likely to be
problematic.
Positive women 7% more at risk and at higher risk of
cervical CA
Screening: 6/12 medical review for skin changes
Self-exam; digital examination to 2-3cm above
sphincter for lumps
Partner inspection
Stop smoking
Logistics of a regular screening?
www.plwhavictoria.org.au
HCV transmission and HIV positive
MSM
Increased risk of HCV transmission








HCV more likely to be found in semen of HIV +ve
people?
Type of sexual activity implicated (group, trauma,
sharing toys, frequency of anal sex)
Duration of sexual activity
Presence of STI
Drug use, route and effects (rectal –ulceration,
duration effecting drugs increase risk of rectal injury)
Action; annual screening for all HIV +ve MSM, ask
about sexual activity, and recreational drug use
Schmidt AJ et al. Risk factors for hepatitis C in HIV-positive MSM.A preliminary evaluation of a case
control study. Fourth International AIDS Society Conference on HIV Pathogenesis, Treatment and
Prevention, abstract MOPEB037, Sydney 2007
www.aidsmap.com
HIV and risks for co-morbidity





Aging
The drugs
Lifestyle risk factors
Genetic predisposition
The HIV virus – persistence of
immunodeficiency, immunodysfunction, and heightened
inflammatory response
Deeks S Immunologic aging: Are antiretroviral treated patient aging too
fast and if so why? Australasian HIV/AIDS Conference 2009 Brisbane
Paper 38