Innovation in medicine 2018: Infectious diseases and sexual health

Day one of Innovation in Medicine 2018 included a fascinating and varied session on infectious diseases and sexual health chaired by RCP academic vice president Professor Margaret Johnson.

It began with a presentation by Professor Chloe Orkin from Barts Health NHS Trust, who explored advances in HIV treatment.

She highlighted some key successes, including:

  • Undetectable = Untransmittable (U=U) – patients whose viral load is undetectable carry no risk of passing on the virus to a partner – this is an incredibly positive advance and an important concept for medical professionals and the public to understand
  • pre-exposure prophylaxis (PrEP) – a drug which can prevent HIV infection is available on a trial in England and on prescription from NHS Scotland
  • instances of HIV diagnosis are going down – especially linked to the work of five clinics in London and due to PrEP, increased testing and earlier treatment
  • medication has improved for antiretroviral therapy – the number of tablets and side-effects is significantly lower
  • life expectancy is now near normal for people diagnosed with HIV.

Prof Orkin revealed that comorbidities such as kidney disease, diabetes and hypertension are increasing as people with HIV are living longer. There is also a higher risk of bone fractures. This is due the effects of HIV on the immune system. These comorbidities need to be managed, especially drug interactions.

HIV patients whose viral load is undetectable carry no risk of passing on the virus to a partner – this is an incredibly positive advance and an important concept for medical professionals and the public to understand

Professor Chloe Orkin, Barts Health NHS Trust

Dr Matthew Dryden from Hampshire Hospitals NHS Trust gave an overview of Lyme disease and whether it was a disease of our time. Caused by the bacterium Borrelia spp. and transmitted by ticks, Lyme disease presents as a characteristic bullseye rash, although some patients never develop this. It then disseminates rapidly through the blood and into the neurological system.

Lyme disease has become ‘fashionable’ recently due to media coverage of celebrities with the disease. Incidence of Lyme disease in the UK (1.7 per 100,000 population) has shown a small rise in the last year or two; however, it is much higher in eastern European countries such as Slovenia (206 per 100,000).

Dr Dryden said that ‘controversies around Lyme disease are due to nearly every area of knowledge attracting disagreement between medical professionals’. This is particularly the case for ‘chronic Lyme’, as there is currently no consensus over whether it exists.

Finally, Dr Seif Salem Al-Abri from the Ministry of Health of Oman gave an absorbing presentation on emerging infections in the Middle East.

He quoted epidemiologist Aiden Cockburn, who in 1963 said, ‘It seems reasonable to anticipate that within some measurable time all the major infections will have disappeared’.

Dr Al-Abri said this was not proving to be the case. He went on to explore infectious disease profiles, patterns of travel and spread in the Middle East.