Hot HIV topics in 2014
7th National HIV Strategy
Five new national strategies addressing HIV, hepatitis B, hepatitis C, sexually transmissible infections (STIs) and Aboriginal and Torres Strait Islander blood-borne viruses (BBVs) and STIs have been released to provide the policy framework for Commonwealth, State and Territory governments and key stakeholders to respond to BBVs and STIs until 2017.
The 7th National HIV Strategy includes several targets that are driven by the Australian Government being a signatory to the 2011 United Nations Political Declaration on HIV/AIDS.
Rapid HIV (point-of-care) testing
A wide range of point of care (PoC) tests is in use in both developed and developing countries. In December 2012, the TGA approved the first PoC test (Alere Determine™ HIV Combo) for use in Australia as a preliminary screening test. On 1 May 2014, the WA AIDS Council’s M Clinic became part of the Kirby Institute’s national trial of PoC testing in clinical settings. For more information visit the M Clinic website (external site).
Amendment to the Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme (PBS) has been amended to broaden the group of HIV-positive people eligible for subsidised treatment. The April 2014 amendment allows doctors to prescribe HIV treatment for people with a CD4 cell count of above 500 cells/mm3 with no clinical symptoms. Previously patients with no clinical symptoms had to have a CD4 cell count of below 500 cells/mm3 to qualify for the subsidy.
The CD4 cell count of an HIV-negative adult is usually between 600 and 1200 CD4 cells/mm3. As a result of the amendment, anyone with HIV and a Medicare card can receive subsidised treatment through the PBS. This enables people diagnosed with HIV to start treatment earlier.
Treatment can reduce HIV to undetectable viral plasma levels. This means that an HIV-positive person is far less likely to pass on HIV to a sexual partner. Current findings show that the risk of HIV transmission is extremely low from a HIV-positive person with an undetectable viral plasma level. This may motivate people to start treatment earlier. Many experts say that untreated HIV causes damage from the time of infection.
Viral load suppression, practising safe sex and adopting safe injecting practices can all reduce the risk of HIV transmission.
Guidelines for post-exposure prophylaxis
Post-exposure prophylaxis (PEP) is a course of antiretroviral drugs used to reduce the risk of HIV infection after potential exposure has occurred.
The national PEP guidelines (external site) were released in 2013.
WA Health’s operational directive on PEP following a non-occupational exposure is currently being updated in consultation with key stakeholders.
Pre-exposure prophylaxis (PrEP) refers to antiretroviral drugs used to reduce the risk of HIV infection before a potential exposure. PrEP is available in a number of countries. The Centers for Disease Control and Prevention (CDC) in the United States recently released guidelines supporting the prescribing of PrEP for high-risk individuals.
PrEP is not generally available in Australia although several demonstration projects and trials are underway in the Eastern States. The aim of these trials is to provide information about the effectiveness of PrEP in Australia and to help develop policies around PrEP that are appropriate for Australia.
Over the next few months, WA Health will develop a position paper on PrEP in consultation with key stakeholders.
20th International AIDS Conference (AIDS 2014)
AIDS 2014 (external site) was held in Melbourne from 20 - 25 July 2014.
WA stakeholders hosted a booth in the AIDS 2014 Global Village. The Global Village was an interactive and participatory space consisting of art exhibitions, installations, film screenings, performances, workshops, networking areas and marketplace booths. It was open to both conference delegates and non-delegates including community organisations from around the world, local and national groups and the general public.The WA booth entitled “Size doesn’t matter in Western Australia” celebrated the uniqueness of WA within the Asia Pacific region. Visitors learnt about WA's partnership approach to HIV prevention and management and its relevance to other remote areas within the Asia Pacific region.