1 / 9

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

haamid
Download Presentation

New Developments in HIV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related