Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment

Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers.

Below:  An integrated postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment transition algorithm. In people reporting mucosal exposure to fluids likely to be infected with human immunodeficiency virus (HIV) in the past 72 hours, start PEP with a 3-drug regimen while awaiting the results of HIV testing. In people with repeated HIV exposures, a negative HIV antibody test, and no signs or symptoms consistent with acute HIV infection, start PrEP with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). A negative test for HIV nucleic acids or antigen is preferred, especially if there are signs or symptoms of an acute viral syndrome. If any HIV test is positive, initiate antiretroviral therapy without delay and send specimens for HIV-confirmatory and drug-resistance testing as soon as possible.

Below:  Sequence of appearance of laboratory markers of human immunodeficiency virus (HIV) infection. The figure is from the updated Centers for Disease Control and Prevention (CDC) guidelines for HIV testing and was adapted from prior publications [36–41].

Full article at: http://goo.gl/mA1WlW

By: Robert M. Grant1,2 and Dawn K. Smith3

¹Gladstone Institutes and University of California, San Francisco

²San Francisco AIDS Foundation, California

³Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Correspondence: Robert M. Grant, MD, MPH, Gladstone Institutes and University of California, San Francisco, 1650 Owens St., San Francisco, CA 94158 (Email: ude.fscu@tnarg.trebor

   

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