HIV Prevention Medicine

Introduction:

Human Immunodeficiency Virus (HIV) continues to be a significant global health concern, affecting millions of people worldwide. There are now more ways than ever to prevent HIV. Some strategies include not having sex, not sharing needles, and always using condoms correctly during sex. There are also medicines available, like PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), that can help prevent HIV. If someone has HIV, some actions can be taken to avoid passing it on to others.

What Are the Different Strategies for HIV Prevention?

The different strategies for HIV prevention include:

• Sexual Education and Awareness: Comprehensive sexual education plays a crucial role in HIV prevention. Providing accurate information about HIV transmission, safer sex practices, and the importance of regular HIV testing promotes awareness and empowers individuals to make informed decisions regarding their sexual health. Education campaigns also contribute to lessening the fear and discrimination connected to HIV, building an environment that is supportive of prevention efforts.

• Condom Use: Consistent and correct use of condoms is an effective barrier method for preventing HIV transmission during sexual intercourse. Promoting condom use, including the availability and accessibility of condoms, encourages safer sexual practices and reduces the risk of HIV infection. Condoms are readily available in various forms, such as male condoms, female condoms, and newer innovations like flavored or textured condoms, catering to diverse preferences.

• HIV Testing and Counseling: Regular HIV testing is a vital component of prevention strategies. Encouraging individuals to get tested for HIV helps identify those who are HIV-positive and unaware of their status. Timely diagnosis enables early access to treatment, reducing the risk of transmission. HIV counseling and support services also play a crucial role in addressing concerns, providing information, and promoting behavior change.

• Pre-Exposure Prophylaxis (PrEP): Pre-Exposure Prophylaxis involves the use of antiretroviral medications by individuals who are at high risk of HIV infection but are currently HIV-negative. PrEP has shown high efficacy when taken consistently and correctly, making it an essential prevention tool for individuals with significant HIV risk factors. According to the Centers for Disease Control and Prevention (CDC), research findings on the effectiveness of PrEP indicate that using PrEP consistently significantly decreases the chances of acquiring HIV through sexual contact by approximately 99 % and through the use of injection drugs by a minimum of 74 %.

• Post-Exposure Prophylaxis (PEP): Post-Exposure Prophylaxis involves the immediate initiation of antiretroviral therapy within a specified time frame (usually within 72 hours) after potential exposure to HIV. PEP is used as an emergency measure following high-risk incidents, such as unprotected sex, needle-sharing, or occupational exposure. Prompt administration of PEP significantly reduces the risk of HIV transmission and is typically recommended for a 28-day duration. Some individuals may experience mild side effects, such as nausea, after taking this medication.

• Harm Reduction Strategies: Harm reduction approaches focus on minimizing the risk of HIV transmission among individuals who inject drugs. Programs such as needle and syringe exchange programs provide access to sterile injection equipment, reducing the sharing of contaminated needles and syringes. Substance abuse treatment, including medication-assisted treatment, counseling, and support services, plays a crucial role in addressing drug addiction and reducing high-risk behaviors.

• Treatment as Prevention : Effective HIV treatment significantly reduces the viral load in individuals living with HIV. When the viral load is undetectable, the risk of HIV transmission during sexual intercourse is greatly diminished. The concept of undetectable equals to untransmittable (U=U) emphasizes that maintaining an undetectable viral load through consistent HIV treatment effectively prevents transmission.

• Behavioral Interventions: Behavior change interventions aim to promote safer sexual practices, reduce the number of sexual partners, and encourage communication and negotiation skills within sexual relationships. These interventions focus on empowering individuals to make informed choices, adopt protective behaviors, and address the underlying social and cultural factors that influence risk behaviors.

• Preventing the Transmission of HIV From Mother to Child: Pregnant women who are HIV-positive take antiretroviral medication to safeguard their own well-being and reduce the risk of transmitting HIV to their babies during the perinatal period. Following delivery, infants born to HIV-positive mothers are administered HIV medication to shield them from potential infection originating from the mother during childbirth.

What Are the Medications Used for HIV Prevention?

Several medicines are used for HIV prevention, offering effective strategies to reduce the risk of acquiring Human Immunodeficiency Virus (HIV) infection. These medications include:

1. Pre-Exposure Prophylaxis (PrEP): The most commonly prescribed PrEP medication is a combination of Tenofovir disoproxil fumarate (TDF) and Emtricitabine (FTC). Other formulations, such as a combination of Tenofovir alafenamide and Emtricitabine, are also available. PrEP is taken daily to maintain protective drug levels in the body.

2. Post-Exposure Prophylaxis (PEP): PEP regimens typically include a combination of antiretroviral drugs, such as Tenofovir disoproxil fumarate, Emtricitabine, and integrase inhibitors like Dolutegravir or Raltegravir. PEP is taken for a prescribed duration, usually 28 days, to reduce the risk of HIV transmission.

3. Long-Acting Injectable Medications: Long-acting injectable medications are emerging as a promising option for HIV prevention. Cabotegravir and Rilpivirine are two long-acting medications that have shown efficacy in clinical trials. These medications are administered via intramuscular injection every four weeks, providing extended protection against HIV. Long-acting injections provide another option instead of taking pills every day. They help with problems like remembering to take medication and feeling ashamed or judged.

Who Should Think About Taking PEP and PrEP?

1. Post-Exposure Prophylaxis is considered under the following circumstances:

• PEP should be considered for individuals who are HIV-negative or do not know their HIV status.

• It is recommended for those who have experienced potential HIV exposure within the last 72 hours.

• Situations that warrant PEP consideration include possible HIV exposure during sexual activity, sharing needles or drug injection equipment, experiencing sexual assault, or potential occupational exposure to HIV.

• Healthcare workers with potential HIV exposure should seek immediate medical attention.

2. Pre-Exposure Prophylaxis is considered under the following circumstances:

• PrEP is for individuals who are HIV-negative but at risk of acquiring HIV through sexual activity or injection drug use.

• Consider taking PrEP if someone has had anal or vaginal sex within the past six months.

• If someone has a sexual partner with HIV, especially if the partner's viral load is uncertain or measurable.

• Have inconsistent condom use.

• If someone has received a diagnosis of a sexually transmitted disease (STD) within the last six months

• PrEP should also be considered if someone engages in injection drug use and:

  1. Have an injection partner with HIV.

  2. Share injecting tools, such as syringes and needles.

Conclusion:

Nowadays, HIV prevention medicine has completely changed the field, providing highly effective methods for those who are at high risk of contracting the virus. Long-acting injectable medications, Post-Exposure Prophylaxis (PEP), and Pre-Exposure Prophylaxis (PrEP) have all shown remarkable effectiveness in lowering the risk of HIV transmission. Seek guidance from healthcare experts who can assess one’s personal risk factors, discuss the benefits and potential side effects of medications, and provide recommendations on the most effective prevention strategy based on their specific circumstances.