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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
The introduction of highly active antiretroviral therapy (HAART) has transformed the clinical landscape of HIV care. For patients, this therapy has brought about improvement in the CD4 count and a fall in the HIV viral load. ‘Treatment as prevention’ means that successful suppression of HIV viral load by HAART makes the risk of transmission of HIV from an infected person to their uninfected partner negligible.Some HAART regimens are now available as combined single-tablet, once a day treatment.Anti-HIV drugs are used as post-exposure prophylaxis (PEP), e.g. for a healthcare worker who receives a needlestick injury from someone with known uncontrolled HIV, or after high-risk sexual intercourse (PEPSI).It has recently been established that prescribing antiretrovirals to people at high risk of acquiring HIV through their sexual lifestyle is effective in lowering transmission (pre-exposure prophylaxis, PrEP).
HIV and Its Complications and Needlestick Injuries
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Post-exposure prophylaxis (PEP) should be given for 28 days, ideally with a three-drug regimen within 72 hours of sexual or occupational exposure. It is not indicated for low-risk exposures or if the source patient has known undetectable viral load. Follow-up HIV testing should be undertaken 8–12 weeks after exposure with a fourth-generation test. The PEP regimen for adults involves 245 mg tenofovir/200 mg emtricitabine once daily as a backbone (250 mg zidovudine/150 mg lamivudine twice daily is an alternative), with a third agent depending on availability (50 mg dolutegravir once daily or 400 mg raltegravir twice daily is preferred or a protease inhibitor such as a combination of 200 mg lopinavir/100 mg ritonavir twice daily.
Case 29
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Very well-conducted research and observational studies have shown a dramatic reduction in risk of acquisition of HIV when medication taken soon after exposure is administered, based on the theory that HIV can be prevented from ongoing infection by doing so. Post-exposure prophylaxis (PEP) is a combination treatment which should be initiated as soon as possible, ideally within 2 hours, and most probably within a limited time frame. It is effective; the rate of infection is reduced by approximately 80%, compared to when PEP is not used.
Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP
Published in The Journal of Sex Research, 2022
Christine M. Curley, Aviana O. Rosen, Colleen B. Mistler, Lisa A. Eaton
There are several other efficacious HIV prevention methods including Post-Exposure Prophylaxis (PEP), a medication taken after potential exposure to HIV, but it is only recommended for use in emergency situations (CDC, 2021a). The U = U campaign (Undetectable = Untransmittable) and Treatment as Prevention (TasP) conceptualize that when an individual who is HIV-positive initiates and adheres to ART to lower their viral load to undetectable levels, they are actively preventing HIV transmission (Kalichman, 2013; Rendina et al., 2020). Negotiated safety is an additional HIV prevention method, in which there is an explicit agreement with established boundaries regarding condom use or exclusivity in the partnership (Kippax et al., 1993, 1997; Leblanc et al., 2017). These methods can be highly effective tools for HIV risk reduction even when engaging in condomless anal sex (Kippax & Holt, 2016), although each method requires reliance and trust on a sexual partner to be aware of their HIV-positive status, to be adherent to ART to achieve an undetectable viral load, or to have open communication about their sexual behaviors with others. These methods may pose further challenges in the U. S., as many MSM living with HIV are unaware of their positive status, and ART adherence remains difficult for many individuals receiving treatment (CDC, 2018).
Does hydroxychloroquine still have any role in the COVID-19 pandemic?
Published in Expert Opinion on Pharmacotherapy, 2021
William HK Schilling, Nicholas J White
In contrast to the wealth of observational data, there have been few RCTs reported. Two pre-exposure prophylaxis trials and three post-exposure prophylaxis trials have now been published in peer-reviewed journals [5–8,11]. Post-exposure prophylaxis (PEP), which may be regarded as a hybrid of prevention and early treatment, would be expected a priori to provide less benefit than pre-exposure prophylaxis. These published studies were relatively small and were powered therefore only to demonstrate large benefits (a minimum of 50% reduction in cases). None were able to reject the null hypothesis. However, the majority did demonstrate non-significant reductions in cases of the order of 15% [63]. So, although the available data from the prevention studies are currently indicative of small benefit, the results are far from conclusive. Dose is also a consideration. Rajasingham et al. in their pre-exposure prophylaxis study used low doses (once weekly and twice weekly dosing, which are closer to those used in malaria chemoprophylaxis) which meant that the levels of hydroxychloroquine were significantly lower than those achieved in the treatment of rheumatological conditions with once daily dosing. This would have reduced the likelihood of a significant antiviral effect [11] although there was a non-statistically significant trend to increased benefit at the higher dose.
Biomedical HIV Prevention among Gay Male Couples: A Qualitative Study of Motivations and Concerns
Published in Journal of Homosexuality, 2021
Stephen C. Bosco, Mark Pawson, Jeffrey T. Parsons, Tyrel J. Starks
Findings suggested that health care access is a substantive barrier to biomedical prevention uptake. In line with previous studies (Haire, 2015; Hubach et al., 2017; Oldenburg et al., 2015), couples reported accessibility challenges perpetuated by a lack of PrEP- and PEP-related knowledge among health care professionals. The financial burden of PrEP and PEP medication, combined with required laboratory and medical services continues to put PrEP and PEP out of reach for many who could benefit (Horberg & Raymond, 2013; Körner et al., 2005). Programs and policies, which facilitate access and financial assistance, may meaningfully enhance biomedical prevention uptake. Gilead, the manufacturer of PrEP, has developed financial assistance as well as insurance programs, to assist those interested in PrEP but who may not have health insurance or the financial means to begin a PrEP regimen. However, the unintentional burden of these assistance programs can be overwhelming for patients as continuous enrollment is dependent upon proof of income and lack of health insurance.