Home

CROI 2020 Report Back

CROI (Conference on Retroviruses and Opportunistic Infections) was scheduled in Boston from 8-11 March 2020. However, with the growing COVID-19 outbreak in the USA, the conference program was transferred to a virtual/digital format. This report back has been provided by NAPWHA Senior Research Manager, Dr John Rule, who has selected some snippets of information, which he has curated our NAPWHA member organisations and NAPWHA Treatment Officer Network.

Prof. Sharon Lewin of the University of Melbourne was one of the first speakers at CROI 2020 and here is her take home slide from her presentation titled ‘HIV Cure from Bench to Bedside’. It is forward looking with a few question marks. Access the presentation webcast recording via the www.croiwebcasts.org

The ‘London’ Patient

Ravindra Gupta first presenting the case at CROI 2019 in Seattle. Photo by Liz Highleyman.

A London man continues to have no detectable HIV 30 months after stopping antiretroviral therapy, according to a report by Professor Ravindra Gupta of University College London at the Conference on Retroviruses and Opportunistic Infections (CROI 2020). When his case was first presented at CROI 2019, he was known simply as the ‘London patient’, but on Monday he, Adam Castillejo, went public with an interview in The New York Times. The latest findings strongly suggest that Castillejo has joined Timothy Ray Brown, formerly known as the ‘Berlin patient’, as the second person to have been cured of HIV.

Weight Gain on ARV Treatment

Weight gain after starting antiretroviral treatment is likely to raise the risk of diabetes but does not push up cardiovascular disease risk, two large analyses presented to CROI 2020 show.

Several randomised clinical trials carried out in sub-Saharan Africa and cohort studies in North America and Europe have shown substantial weight gain occurs after starting antiretroviral treatment, particularly in black women and people exposed to both dolutegravir and tenofovir alafenamide (TAF).

 

Long Acting Injectables

Long-acting injectables might be administered every two months

A combination of two long-acting injectable drugs administered every two months suppresses HIV viral load as well as monthly injections, according to a report at CROI 2020.

Treatment that can be taken every other month would improve convenience and possibly adherence. However, in this study, those who received the every-other-month regimen were more likely to develop resistance if they did not maintain viral suppression.

Other interesting CROI 2020 links


 

Information of Truvada and Atripla delisting

NAPWHA and AFAO wish to update our HIV community/ies and organisational members that from 1 April 2020 Truvada ® for HIV treatment and for pre-exposure prophylaxis (PrEP) will no longer be available through the Australian Pharmaceutical Benefits Scheme (PBS).

There are alternatives to Truvada ® for PrEP in Australia. Community members eligible for PrEP can access generic versions of Truvada supplied by Apotex, Mylan and Lupin Generic Health. The drugs manufactured by these three suppliers contain the same active ingredients as Truvada.

In addition, from October 2020 Atripla ® will be delisted. A generic equivalent of Atripla has been approved by the PBS for community members who wish to continue using Atripla.

We encourage you to talk to your prescribing doctor if you want more information about these changes.

For more information, visit the following websites:

Managing community concerns about ARV supply

The importance of consistent HIV health sector messaging

The current COVID-19 crisis has raised concerns about HIV treatment supply in Australia. Despite continued assurances that supply is not, nor is likely to be compromised, rumours to the contrary persist.

This speculation has the potential to raise anxiety levels and cause consumer panic. Maintaining message consistency across the HIV health workforce is vitally important at this time.

When patients or customers register concern about the supply of HIV medications, please reassure them with the following messages:

  1. The pharmaceutical companies that supply antiretrovirals (ARVs) in Australia have given assurances that there is no shortage. There are enough HIV treatments in the country right now to meet the needs of people with HIV for many months.
  2. Stock-outs or delays in re-stocking ARVs at a local pharmacy does not mean that national supply is limited.
  3. In the unlikely event of an impending shortage of a particular ARV, the TGA would add it to this publicly available list and then take action to ensure ongoing access for people living with HIV taking that medication. NB: There are no ARVs currently on this TGA list.
  4. It is important to keep taking HIV treatments as prescribed. People with HIV should not skip doses or share medication with friends who are worried about their own supply.
  5. Prescriptions for ARVs are currently limited to two months’ supply at a time and this is standard for everyone. To minimise trips to the pharmacy, arrangements are in place so people living with HIV can have their medications posted to them. For more information about this issue please talk with your pharmacist.

NAPWHA has issued this communication with Australian Federation of AIDS Organisations (AFAO) and Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) on 3 April 2020.

Nurse Practitioners included as authorised prescribers for HIV, hepatitis B and hepatitis C medicines

Nurse Practitioner s100 Prescribing: What does this mean?

From 1 April 2020, Nurse Practitioners (NPs) experienced in the care and management of people living with HIV, hepatitis B and hepatitis C are eligible to prescribe Pharmaceutical Benefit Scheme (PBS) funded medicines for treatment of these blood borne viruses. NPs can already prescribe medicines to treat hepatitis C for people living in the community, but now they can also prescribe Hepatitis C medicines for people in prisons. Expanding NP prescribing to include HIV, hepatitis B and hepatitis C medicines will improve access to care for people who have a NP in the health service that they visit.

NPs have been an integral part of the Australian health system for 20 years and have been safely and effectively prescribing medicines in Australia since 2010, including Pre-Exposure Prophylaxis (PrEP) for the prevention of HIV and treatment for hepatitis C.

They already provide care to many people living with HIV, hepatitis B and hepatitis C in major cities, regional, rural and remote towns through health services such as:

  • Sexual health clinics
  • Hospitals
  • General practices
  • Aboriginal and Torres Strait Islander health services
  • Community health centres
  • Prisons

What is a Nurse Practitioner?

Within our healthcare system, NPs are the most senior nurses working in clinical settings.  They have completed postgraduate Masters degree level study and are registered with the Nursing and Midwifery Board as Nurse Practitioners.  NPs are already able to:

  • Provide expert healthcare to all members of the community
  • Raise awareness of health promotion activities and strategies for disease prevention with community members
  • Write prescriptions for patients to access Pharmaceutical Benefits Scheme (PBS) medicines for many health conditions
  • Order x-rays and tests to diagnose health conditions
  • Refer patients to a specialist or hospital if needed
  • Collaborate with other health professionals, for example, General Practioners, Infectious Disease Clinicians and Sexual Health Physicians, physiotherapists, social workers and occupational therapists to support people to manage their health and wellbeing

To prescribe HIV and hepatitis B medicines NPs need to complete an accreditation course. This means some NPs may not be able to prescribe your next script immediately but will be able to do so in due course. ASHM is currently adapting its education courses for online delivery, including the HIV and Hepatitis B s100 Prescriber courses. The process of adaption might delay the commencement of accreditation courses.

Community members are encouraged to talk with their NP to discuss these changes and what they mean for them.

Search for a Nurse Practitioner by location

You can search for accredited NPs, by location, on the ASHM website:

ASHM is a peak organisation of health professionals in Australia and New Zealand who work in HIV, viral hepatitis, other BBVs and sexually transmissible infections. They are the national accreditation education provider for continuing medical education for community practitioners who prescribe s100 medications in HIV. 

Treatment Outreach Network 2020 meeting held online during COVID-19 restrictions

NAPWHA’s Treatment Outreach Network – a membership of professionals from Australian State and Territory peer-based organisations and AIDS Councils, held their annual formal meeting via video conferencing during this time of COVID-19 restrictions.

Hosted and facilitated by NAPWHA, the network work together to optimise the overall wellbeing of people living with HIV (PLHIV) and those affected by HIV, by providing a high standard of information and care on issues of health and treatments for HIV.

Two video conference calls were held on 8 and 15 April 2020 to hold initial roundtable discussion regarding disruptions to frontline services and responses to the impact of COVID19. A third video call hosted various presenters speaking on themed subjects, including Dr Elizabeth Crock, Vikas Parwani, Dr Darren Russell, and Associate Professor Edwina Wright. Video recordings of these sessions are featured below.

Referral pathways to PLHIV services and Nurse Practitioner community practicing

Dr Liz Crock (HIV Clinical Nurse Consultant) provided members with a question and answer (Q&A) session that allows members to better understand the referral processes and navigating social services for ancillary care arrangements for clients living with HIV.

Government Funded Income Support during COVID-19: Who’s eligible and who’s left behind

Vikas Parwani (Solicitor of The HIV/AIDS Legal Centre – HALC) provided members with a presentation on the delivery of current information on welfare service supports.

Clinical supports for PLHIV during COVID-19 including telehealth and CovidSafe app

Dr Darren Russell (Director of Sexual Health, Cairns Hospital) provided members a presentation and Q&A about clinical supports that are being put into place to enable people living with HIV (PLHIV) to better access services and understand the current situation in relation to COVID-19.

  • Could you give us some of your thinking on the [Australian Government’s] COVID Safe Tracking app launched on 26 April 2020 and people living with HIV – e.g. public health benefits versus privacy concerns?
  • Do you see the COVID Safe Tracking app being used in [workplace setting] as a [mandatory] occupational health and safety tool?
  • Is it possible that those protection laws may change down the line? Who is going to ask permission from you to access your information?
  • Could you tell us a bit about Telehealth from the clinical perspective? What’s working, what’s not? Will we in Australia be seeing it stick around?
  • What privacy and confidentiality measures are put into place for people sending data and information in through Telehealth platforms (e.g. video calls, SMS?)
  • Are numbers of people presenting at clinics and HIV-STI notifications going down or changing during this period?

Current data on COVID-19 and how it applies to PLHIV

Associate Professor Edwina Wright (Head of HIV Prevention Service, Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University) provided members a presentation and Q&A about the most current data on COVID-19 and how it applies to PLHIV, their treatment and long-term health.

Edwina is the Chair of ASHM’s Taskforce on BBVs, Sexual Health and COVID-19 was established on 20 March 2020. It provides a timely opportunity for the BBV and sexual health sectors to discuss the scientific, clinical, BBV and sexual health service delivery and social implications of COVID-19, and provides consistent and evidence-based messaging to the health workforce, sector partners and community.

About the NAPWHA Treatment Outreach Network

The Treatment Outreach Network (TON) is a network of professionals working together to optimise the overall wellbeing of people living with HIV (PLHIV) and those affected by HIV, by providing a high standard of information and care on issues of health and treatments for HIV.

The membership of Treatments Officers throughout Australia and New Zealand, working for their State and Territory peer-based organisations and AIDS Councils are called together by NAPWHA under this program to provide peer support/navigation and to promote the sharing of information. The network meets formally once per year and informal communication occurs throughout the rest of the year to continue the work of the network.