Selected webcasts from BHIVA Autumn conference 2015
Simon Collins, HIV i-Base
As with previous meetings, the BHIVA Autumn conference included important presentations that are available as webcasts after the meeting.
All the talks at BHIVA are important, but the selections below are perhaps essential for a UK audience. These presentations ranged from around 15 to 30 minutes – easy to watch – of course you can find this time.
- BHIVA treatment guidelines 2016: important changes compared to commissioning guidelines
- Implementing PrEP within a sexual health clinic
- HIV and ageing – a review of the evidence
- The importance of peer support in HIV care
- Smoking cessation – a review for HIV management
- The disclosure of an HIV positive adult to their HIV negative child
- Osteoporosis and HIV
- Hormone Replacement Therapy (HRT): managing HIV through the menopause
- Stigma Index Study: a continued issue in the UK
BHIVA treatment guidelines 2016: important changes that conflict with commissioning guidelines
Dr Duncan Churchill and Dr Laura Waters
A clear and unequivocal review of the evidence for universal access to ART at any CD4 count, now supported by the strongest rating. This includes a new recommendation for recent HIV infection (<12 weeks) as an indication for immediate ART, as is Treatment as Prevention.
With >90% of diagnosed people already on treatment, this recommendation directly affect about 7,000 people. Indirectly, the stronger recommendation is hoped to reduce late diagnosis in the UK.
The talk raised the importance of resolving the conflict between the new BHIVA guidelines and current NHS commissioning which is still based on 2012 guidelines. The CRG currently proposes to only undertake a review of TasP in England as a “workplan item for 2016/17” and to only “develop a policy proposition for 2017/18” unless it meets criteria for in-year service development. The recommendation from BHIVA is that clearly this needs to be resolved in year.
Dolutegravir and rilpivirine (within its license for <100,000 viral load) have been added to preferred third-drug options for first-line combinations. Efavirenz has been downgraded from a preferred to alternative option. Tenofovir/FTC is the preferred dual NRTI backbone with abacavir/3TC included as an alternative. Dual darunavir/r plus raltegravir is included as an alternative for people with CD4 counts >200 cells/mm3 who have no NRTI options.
The impossibility of cost effectiveness analysis was made in the context of a UK pricing structure that is “regionally variable, rapidly changing, and made behind closed doors”.
The guidelines are dedicated to Dr Martin Fisher.
Implementing PrEP within a sexual health clinic
Dr Mags Portman
This presentation on PrEP highlighted the under-appreciation of individual risk experienced by many HIV negative people, the practical experience of providing PrEP, and the high efficacy reported from programmes where PrEP is now widely available.
The talk showed how most of the services needed to support someone on PrEP are already routinely available free on the NHS. This includes HIV, HBV and other STI testing, discussing and supporting strategies to reduce HIV risk, recreational drug assessment and awareness of seroconversion symptoms and PEP.
The additional services of baseline and routine renal function (3 monthly urinealysis and 6-12 monthly creatinine) are cheap (“it costs pence”) plus adherence counselling (including a benefit/risk discussion) that could easily fit within current risk awareness discussions.
The presentation noted that US, European and WHO guidelines already strongly recommend availability of PrEP for people at high risk of HIV infection.
Two quotes: “If PrEP remains unfunded it will remain an unregulated party drug… and drug levels might not be effective in this setting”; and “We can talk to service users and colleagues about PrEP. We can inform them where to get PrEP based on community websites. We can talk about pleasure to reduce stigma. People are making a positive choice to take PrEP, they know they are at risk”.
Note: this presentation is the second PrEP talk, starting at 12 minutes in the webcast link.
HIV and ageing – a review of the evidence
Professor Brian Gazzard
An overview lecture that broadly set out to allay concerns that growing older is necessarily associated with a range of increased risk of other comorbidities for HIV positive people compared to people who are HIV negative.
This promising outcome is dependent on access to effective ART and adoption of lifestyle changes linked to better health in the general population.
Although these conclusions were reached by a route that included a sometimes less-than-evidence-based criticism of cohort studies, HIV related inflammation, global warming, BHIVA research grants and CHARTER neurological research, this is an easy talk to watch with important references to current research.
The importance of peer support in HIV care
Laura K, Marc Thompson, Alex Sparrowhawk and Dr Ian Williams
The four presentations in the community symposium focused on different approaches to peer advocacy including the practical examples from the Mortimer Market which was the first NHS clinic to employ peer advocates as a core part of their HIV services.
These are important talks for any clinic that wants to develop better and cost effective services for their patients.
Smoking cessation – a review for HIV management
Dr Louise Restrick
Excellent talk from a respiratory disease doctor talking about COPD, lung cancer and other respiratory diseases based on ten years experience with smoking cessation programmes – now reporting 50% quit rates at 6 months.
Almost 40% of people diagnosed with COPD are still smokers after their diagnosis – a figure unchanged for the last ten years: smoking and nicotine dependence is addictive. As such, it is a chronic condition often started in childhood.
Smoking cessation – with new medication for nicotine replacement (including varenicline) and shared decision making – is, at £2000 per QALY, one of the most cost effective medical interventions.
The talk emphasised the importance of actively asking about and recording smoking status – both cigarettes and cannabis; having a cessation specialist in any team; including a carbon monoxide monitor as a motivational tool; and wide use of nicotine replacement treatment.
More HIV positive life years lost are from smoking compared to HIV (importantly referenced in two key studies: by Helleberg M et al. in CID 2013 and AIDS 2015).
The disclosure of an HIV positive adult to their HIV negative child
Rebecca Brown and Angelina Namiba
As part of the shared programme with CHIVA this talk included two perspectives – one a first-hand account – on the complex issues of telling your child that you are HIV positive: sharing, naming, telling and talking rather than the loaded term “disclosure”.
Osteoporosis and HIV
Dr Karen Walker-Bone
Excellent overview about HIV and bone health including screening and management.
Hormone Replacement Therapy (HRT): managing HIV through the menopause
Dr Shema Tariq
The first time that BHIVA included an overview of the under-researched issues of HIV and menopause. This is an issue that is likely to affect up to 10,000 HIV positive women in the UK over the coming years.
Menopause was discussed as a process taking place over many years (median duration 7 years). Most women (85%) are likely to experience symptoms, with 1 in 4 likely to be sufficiently severe to affect daily life. Menopause has both biological and cultural impact.
This talk includes information about new NICE guidelines on management with HRT and the upcoming UK HIV PRIME study.
Stigma Index Study: a continued issue in the UK
Alastair Hudson, Rebecca Mbewe and Dr Valerie Delpech
This report from the 2015 community initiated stigma index survey included more than 1500 HIV positive people across the UK, a third of whom are from black and minority communities. Preliminary results reported that almost half the sample have had HIV-related issues of negative self image over the previous year and that this correlated with avoiding non-HIV healthcare such as GP and dental services.
Fear of disclosure related not just to personal relationships but also to job security.
More than half the sample said that disclosure issues had led to avoiding development of specific relationships. Just under one third of the sample had been rejected by a potential partner because of their HIV status, with about 1 in 10 discriminated against at family settings and another 1 in 10 being denied health services.