About 130 family physicians and Nurses from the Parkway Hospitals attended the “ Meet the Infectious Disease Specialists on VIV” at the Regent Hotel on May 12 2018.

Dr Lui Hock Foong, gastroenterologist at H F Lui Digestive & Liver Clinic, started with overview of HBV. Out of the 2 billion people with past and present HBV infection, 250 million have severe HBV and up to 800,000 deaths annually.

Dr Lui divided his talk into the following areas:

– What ‘s new in diagnosis -compared the MR elastography vs Fibroscan for non invasive fibrosis assessment

– What ‘s new in vaccination – his discussed the management of HBV vaccine non-responders

– What’s new in liver cancer surveillance – he elaborated on the methods of surveillance

– What’s new in serology – he elaborated on Quantitative HBsAg

– What’s new in the treatment of HBV infection?

Dr Wong Sin Yew’s talk was on Viral Diagnostics. He provided an update on the revolution in viral diagnostics in the past 5 years utilising PCR and whole genome sequencing (WGS). Dr Wong discussed the findings of the “EPIC” study and emphasized the role of viral infections in community acquired pneumonia (CAP) in adults. He then discussed Syndromic Testing in other infectious disease syndromes using Multiplex PCR. In the management of chronic viral infections such as HIV, HCV and HBV, the suppression of viral load with appropriate antiviral(s) has been used as a surrogate marker for survival benefit, reduction in cancer risk, reduce morbidity, transmission risks. In the area of public health, WGS is being recognised as a vital tool and has been used for investigation of outbreaks of viruses and bacteria. In between the topics on viral diagnostics, Dr Wong provided case studies to illustrate teaching points.

Dr Lee Tau Hong, Consultant at Department of Infectious Diseases, Tan Tock Seng Hospital spoke on the topic of Hepatitis C virus infection in Singapore and the role of Direct-acting Antivirals (DAA). In his talk, he covered the following:

• Basics of HCV: positive, stranded RNA virus with 7 genotypes identified, transmission is by contaminated blood/blood products, sexual contact and vertical (mother to child) routes
• Global burden of Hepatitis C – affects 180 million, leading cause of hepatitis, cirrhosis, and liver cancer and a primary indication for liver transplantation in the Western world
• Situation in Singapore – The prevalence of hepatitis C infection in Singapore is not well studied. Intravenous drug users account for a significant proportion of persons with chronic hepatitis C
• Natural history of hepatitis C infection- Acute infection is mild and infrequently diagnosed. Transition to chronic infection is usually subclinical, Risk of cirrhosis increases with longer duration of infection, older age at the time of exposure male sex, co-infection HBV or HIV, and daily alcohol consumption
• History of treatment strategy – pre-DAA era -the milestone in HCV research and treatment Next advances in treatment
• Era of direct-acting antiviral agents –He elaborated on the SVR rates of the various treatment regimens
• Future directions – Multiple effective regimens are available for the treatment of HCV, with a few that are pan-genotypic regimens. With   the success of current regimens, there are only a few new   drugs in the pipeline and some pharmaceutical companies have halted R&D of new compounds

Dr Lam Mun San, discussed the topic of HIV Prevention & the role of Pre-exposure prophylaxis (PrEP). She spoke on the recent HIV vaccine trials, the rationale and motivation for the pursuit of a vaccine, and the challenges in developing a HIV vaccine She also elaborated that ART treatment is an important HIV prevention strategy and reiterated the UNAIDS goals of “90-90-90” by 2020, “95-95-95” by 2030 and zero transmission in 2030.

For PrEP, Dr Lam discussed the rapid reduction in HIV incidence after PrEP introduction in some studies. She compared Pre versus Postexposure Prophylaxis and the recent efficacy data for PREP. She also included CDC’s guideline on PrEP recommendations, the regimens used, and some of the concerns raised with PrEP. Dr Lam concluded that recent research has allowed us to understand the virus better and we are closer to achieving “eradication” and “cure”. She predicted that there will be an effective vaccine possibly in the next 10 years.

We wish to thank our 2 guest speakers Dr Lui and Dr Lee for giving great talks at the seminar and for engaging well with our family medicine participants. We also wish to thank our sponsor, DCH Auriga for helping to co-organise and providing logistical support for our seminar.