Which exposure would NOT be an indication for Post Exposure Prophylaxis (PEP) in an Australian (low HIV prevalence) context?
A man presents after sharing needles with another man who he believes may be HIV positive.
A woman presents following receptive anal intercourse with a HIV + source known to be well controlled on antiretroviral therapy
A lady presents after unprotected vaginal intercourse with a man from a high HIV prevalence country
A healthcare worker presents following a needlestick injury in a patient with poorly controlled HIV’
New evidence from the partner study suggests that the chance of HIV transmission from a viral load suppressed source is negligible. This groundbreaking study of 1166 serodiscordant partners in whom the HIV+ partner had viral suppression reported 0 cases of HIV transmission between the partners, despite 22,000 condomless sex acts among MSM and 36000 among heterosexual partners. The study was powered to give a 95% upper confidence of 0.3/100 couple years of condomless sex, suggesting that the risk is lower than it was previously thought to be a few years ago.
Add in the the weight of new evidence about the morbidity benefits of ART in the SMART and TEMPRANO trials has led to recent changes in WHO and Australian ASHM, which now recommend starting antiretroviral therapy in almost all HIV patients.
A, C, and D would all be indications for PEP by Australian guidelines. B would not be a indication, nor would even unprotected receptive anal sex with a source with unknown HIV status from the standard Australian low prevalence community – although it could be considered if the source was from a higher prevalence group – eg a country with higher prevalence or a subgroup like IVDU. Remember, this more conservative administration of PEP reflects both new evidence and low Australian prevalence, and many countries might have higher prevalence or not have updated older more conservative guidelines yet.
For tons of extra information including probabilities of transmission risks by different exposures and current indications for PEP check out ASHMs great guidelines here.
Dont forget your PrEP and barrier protection for this intimate all-male episode as Scott and Rahul take you through the racey fundamentals of HIV – from virology and antivirals to the unadulterated thrill of municipal libraries.
And keep the knowledge pot simmering with Lucy’s great summary here
Ever pondered whether you might suit the professorial lifestyle? This episode, featuring special guests Dr. Adam Brown and Dr. Nitesh Nerlekar, will run through what the appeals of including research in your career are and some basics on how to get started. Drs. Brown and Nitesh are academic cardiologists from Monash Health in Melbourne and have mentored many medical students, junior doctors and PhD candidates in their nascent careers. So sit back, grab a Pina Colada and get caught in the research rain.
Nitesh, Adam and Rahul (alongside a few other academic doctors) are running a research skills course in Melbourne at the Alfred Hospital over the weekend of May 19-20. This course will provide a more in-depth guide on the skills needed get some publications to your name and avoid some of the traps that many young doctors fall into. You can sign up at www.medcube.com.au
Rahul is temporarily back in our fair island nation, so here’s a cis-pacific podcast on cirrhosis. Part two will follow eventually, but like the course of this chronic disease, you probably know that the natural history of MedConversations can sometimes be slow and unpredictable. Sorry about that.
This one’s a shout out to the new interns, the soon-to-be interns and anyone who needs a refresher. But mostly it’s for the pharmacists, who are worried about using up the national stocks of purple ink.
Today we discuss swiss traditional dress. High-waisted skirt, embroidered blouse, shawl, and a nice kropfband to show off that shapely toxic thyroid adenoma.
You’ll hear there’s a new voice joining us for this one – meet Scott, our delightful physician-in-training friend with a keen eye for historical factoids and dulcet tones that will ease the transfer of medical knowledge into your auditory canals.
Benjamin Franklin once wrote a play. The two main characters were himself, and gout, and most of the dialogue is along the lines of “eh! oh! eh!”. If you want to learn about gout, probably just read that. But here’s a podcast episode to supplement your learnings.
Excerpt from Dialogue Between Franklin and the Gout
Benjamin Franklin, midnight, 22nd October, 1780
FRANKLIN. Eh! Oh! Eh! What have I done to merit these cruel sufferings?
GOUT. Many things; you have ate and drank too freely, and too much indulged those legs of yours in their indolence.
FRANKLIN. Who is it that accuses me?
GOUT. It is I, even I, the Gout.
FRANKLIN. What! my enemy in person?
GOUT. No, not your enemy.
FRANKLIN. I repeat it; my enemy; for you would not only torment my body to death, but ruin my good name; you reproach me as a glutton and a tippler; now all the world, that knows me, will allow that I am neither the one nor the other.
GOUT. The world may think as it pleases; it is always very complaisant to itself, and sometimes to its friends; but I very well know that the quantity of meat and drink proper for a man who takes a reasonable degree of exercise, would be too much for another, who never takes any.
An awful disease particularly relevant in cold Melbourne. Promising therapies on the horizon though, and I like to think my scamming of the readathon as a 9 year old to get some sweet loot played a part.