Other selections and webcasts

24 April 2017. Related: Conference reports, Antiretrovirals, Coinfections and complications, Hepatitis coinfection, Cure-related research, BHIVA 23rd Liverpool 2017.

Simon Collins, HIV i-Base

In addition to the studies reported above, many other studies included important results. A selection of these are included below.

Generics: the facts

Andrew Hill from the University of Liverpool in the first of five BHIVA invited lectures, argued that now many widely used HIV drugs have come off patent, incremental cost from newly approved ARVs such as dolutegravir and tenofovir alafenamide need to be reduced to remain cost-effective relative to the new price of generic-based combinations.

The talk covered HIV and hepatitis C comparing the more ambitious Australian government programmes for broader access to both PrEP and direct acting antivirals for hepatitis C.

Reference:

Hill A. Generics: the facts. BHIVA invited lecture 1, Thursday 6 April 2017.
http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170406/JohnFrater.pdf (PDF)
http://www.bhiva.org/170406AndrewHill.aspx (webcast)

Suicide in HIV positive people

Sara Croxford from Public Health England presented an analysis of suicide deaths in HIV positive people compared to the general population.

From 1997 to 2012, 96 suicide deaths in HIV positive people accounted for 1.8% of the 5302 deaths, representing a mortality rate of 2.1 per 10,000 patient years (95%CI: 1.8 to 2.6).

This was more than double the rate for the general population, matched by sex and age (SMR 2.0; 95%CI 1.6 to 2.4), driven by significantly higher rates in men.

Rates were highest within the first year of diagnosis.

Reference:

Croxford S et al. Suicide among people diagnosed with HIV in England and Wales compared to the general population. Oral abstract O16.
http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170406/SaraCroxford.pdf (PDF)
http://www.bhiva.org/170406SaraCroxford.aspx (webcast)

Acute hepatitis C in HIV negative gay men

Laura Midgely presented results from a case review of acute HCV diagnoses from patients attending the Mortimer Market sexual health services between April 2015 to April 2016.

The study was prompted by increasing reports of sexual HCV transmission, when condomless sex was reported as the only risk factor. Risk factors were assessed based on case notes and included ChemSex, injecting or snorting drugs, STI history, PrEP use, fisting, and condomless sex.

Of the 48 cases identified, 81% were gay men (including 16 gay men who were HIV negative), 13% women and 6% heterosexual men. Overall, two-thirds of the diagnosis were in HIV positive patients.

Condomless sex was reported as the only risk factor for 19% of the HIV positive group compared to none of the HIV negative group. ChemSex, use straws and IV drug use in the positive vs negative men was reported by 53% vs 38%, 53% vs 38%, and 31% vs 44% respectively. STIs were significantly higher in the HIV positive group (59% vs 6%), but fisting was low in both groups (3% vs 6%).

Although there are limitations for assessing risk factors from retrospective case notes, this signal confirms previous reports that HCV can be sexually transmitted from condomless sex, especially for HIV positive men.

Reference:

Midgley L et al. Acute hepatitis C infection in lower risk MSM: an evolving picture. Oral abstract O24.
http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170406/LauraMidgley.pdf (PDF)
http://www.bhiva.org/170406LauraMidgley.aspx (webcast)

Scientific advances – including cure research

The potential for new technological advances to affect HIV research was given by John Frater from the University of Oxford. These include:

• Advances in single cell technologies that enable massive scale up of research capacity with simpler lab facilities, for example in screening compounds and in rare cell populations.
• Gene editing technologies, including CRISPR/Cas9 and advances in HIV broadly neutralising monoclonal antibodies.
• The recent discovery of a new marker for latently infected CD4 cells (CD32a) that could be a key step in HIV cure research.

Reference:

Frater J. An overview of basic science discoveries that will impact upon clinical practice. BHIVA invited lecture 1, Thursday 6 April 2017.
http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170406/JohnFrater.pdf (PDF)
http://www.bhiva.org/170406JohnFrater.aspx (webcast)

HIV and neurological complications

Two presentations at BHIVA 2017 focused on neurological symptoms and HIV associated neurological disorders (HAND) in HIV positive people.

Tristan Barber, from the Chelsea and Westminster Hospital presented a practical approach to the complexity of interpreting neurological symptoms and clinical management of HAND, including a stepped-care model for psychological wellbeing.

Paul Holmes from St Thomas’ Hospital gave an overview of the pathobiology of HAND, the role of CSF biomarkers and other causes of neurological impairment.

References:

1. Barber T. Neurocognitive symptoms in people with HIV. BHIVA invited lecture 5, Friday April 2017.
   http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170407/TristanBarber.pdf (PDF)
   http://www.bhiva.org/170407TristanBarber.aspx (webcast)
2. Holmes P. Neurocognitive symptoms in people with HIV. BHIVA invited lecture 5, Friday April 2017.
   http://www.bhiva.org/documents/Conferences/2017Liverpool/Presentations/170407/PaulHolmes.pdf (PDF)
   http://www.bhiva.org/170407PaulHolmes.aspx (webcast)