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New Developments in HIV

New Developments in HIV. Kerri Howley Coordinator – The Green Room khowley@mshc.org.au. 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

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New Developments in HIV

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  1. New Developments in HIV Kerri Howley Coordinator – The Green Room khowley@mshc.org.au

  2. 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

  3. 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

  4. Babies and HIV -Chronic Viral Illness ProgramRWH • 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. HIV and risks for co-morbidity • Aging • The drugs • Lifestyle risk factors • Genetic predisposition • The HIV virus – persistence of immunodeficiency, immuno-dysfunction, 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

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