Transgender women
Transgender women have a high prevalence of HIV infection 8 and experience high HIV incidence rates compared to non-transgender men and women 9. Furthermore, transgender women have represented less than 1% of study participants in PrEP trials 10 and this paucity of data may help explain the overall low uptake of PrEP by transgender women […]
People ineligible for Medicare including newly-arrived Asian-born men who have sex with men
Reports during 2013-2017 from a large, sentinel sexual health service in Victoria showed that the proportion of newly-arrived Asian-born MSM with incident HIV infection did not decline whereas the proportion of all other MSM attending the clinic with incident HIV infection declined by 45% 6. At the same clinic during 2017, newly-arrived Asian-born versus all […]
Aboriginal and Torres Strait Islander people
The rate of human immunodeficiency virus (HIV) infection is rising in Aboriginal and Torres Strait Islanders (hereafter referred to as Indigenous) Australians. Between 2013-2017, the age standardised rate of HIV notifications increased by 41% in Indigenous populations, compared to a 12% decline in Australian-born non-Indigenous people (1). Furthermore, a greater proportion of HIV notifications during […]
References
Australasian Sexual Health Alliance (ASHA). Australian STI management guidelines for use in primary care[internet]. Last updated December 2018. Available at: http://www.sti.guidelines.org.au/ (last accessed 30 August2019). Masciotra S, McDougal JS, Feldman J, Sprinkle P, Wesolowski L, Owen SM. Evaluation of an alternative HIVdiagnostic algorithm using specimens from seroconversion panels and persons with established HIV infections. JClin Virol 2011 […]
Optional assessments
Therapeutic drug monitoring Initial demonstration projects in Australia conducted therapeutic drug monitoring as part of research protocols to evaluate medication adherence and HIV seroconversions among study participants. Their results revealed a high correlation between self-reports of tablet taking and blood concentrations of TD* and FTC, and high adherence to PrEP (over 90%) 15, 16. However, in Australia there […]
Managing side-effects
Patients taking PrEP should be assessed for side-effects associated with TD*/FTC use, most importantly those suggesting possible acute renal injury. A review of symptoms experienced in the iPrEx (Iniciativa Profilaxis Pre-Exposición) study showed that potential PrEP-associated symptoms peaked at 1 month, when 39% of participants reported symptoms, compared with 22% at baseline. Gastrointestinal (GI) symptoms occurred in […]
Monitoring HBV Hepatitis B and HCV Hepatitis C virus infections
Hepatitis B virus monitoring For people who are hepatitis B virus (HBV) non-immune at baseline, clinicians should provide hepatitis B vaccination and confirm their immune response 1 month after the last vaccine dose. For people who state that they have been vaccinated for hepatitis B at baseline, clinicians should test for hepatitis B surface antibody; if their […]
Testing for STIs
As PrEP users are at increased risk for STIs 7 clinicians should screen for STIs (specifically gonorrhoea, chlamydia and infectious syphilis) every 3 months using the standard-of-care tests and procedures, and manage any detected STI as recommended by the Australian STI Management Guidelines 1. Partner notification should be undertaken using the most appropriate available resources. It is important […]
Monitoring of renal function
Renal function should be monitored at 3 months and 6 monthly thereafter, or more frequently in certain populations (see Assessment of renal function at baseline). The management of people with high and ongoing risk of HIV infection, but whose eGFR has declined below or around 60 mL/min/1.73 m2 since commencing TD*/FTC, is challenging. This situation […]
A recent high-risk exposure (within 72 hours)
A course of non-occupational post exposure prophylaxis (nPEP) may be required if a patient is on daily PrEP, or on-demand† PrEP and had a recent high-risk exposure (within 72 hours) but only if they did not take PrEP during those days. This nPEP may need to consist of a three-drug regimen, depending on the nature of the exposure. See […]