Definition of HIV / AIDS
Acquired immunodeficiency syndrome is a chronic, potentially life-threatening condition caused by the human immunodeficiency Virus. Now, by damaging the immune system, HIV interferes with the body’s ability to fight infection and disease.
Undetectable = Untransmittable (U = U)
Pre-exposure prophylaxis when taking consistently can reduce the risk of HIV by up to 92%.
The risk of transmitting HIV is reduced by 96% in those who start treatment early.
There is no denial of coverage for pre-existing conditions, like HIV.
Federal HIV treatment guidelines now recommend antiretroviral therapy for all people living with HIV
How is HIV transmitted?
HIV infection is caused by the human immunodeficiency virus. You can get HIV from contact with infected blood, semen or vaginal fluids. Most people get the virus by having unprotected sex with someone who has HIV. Another common way of getting HIV is by sharing drug needles with someone who is infected with HIV.
How do you protect yourself from HIV?
Consistent and CORRECT CONDOM USE decreases HIV transmission by approximately 80% among serodifferent heterosexual couples and reduces the per contact risk of HIV infection by 78% among same sex couples. You can also protect yourself from HIV by avoiding needle sharing.
What are Pre-exposure prophylaxis?
Pre-exposure prophylaxis is an important prevention strategy. The expanded use of PREP is a major component in the national Initiative ending the HIV epidemic which is a plan for the united states. The Fundamental principle with current PREP strategies used is that an individual who does not have HIV takes daily antiretroviral medications to prevent HIV acquisition in the event of an exposure to HIV. More recently, data from the phase three DISCOVER TRIAL showed that Tenofovir Alafenamide- Emtricitabine was non-inferior to Tenofovir Disoproxil-Emtricitabine for PREP in cisgender men who had sex with men and transgender women who had sex with men. At this time in the united states, there are two medications approved for HIV PREP : Truvada and Descovy.
What are Post-exposure prophylaxis?
PEP is preventive medical treatment started after exposure to HIV. HIV medicines are taken at least 72 hours (3 days) after such exposure. If parameters established by your doctor are met, a 28 day course of antiretroviral medications for non-occupational or occupational post exposures are followed. For adults, the CDC recommends tenofovir, emtricitabine and either raltegravir or dolutegravir.
When are prophylaxis recommended?
1. A person has had a non occupational exposure to blood, genital secretions or other potentially infectious body fluids from a person known to be infected with HIV OR
2. The exposure represents a substantial risk for HIV transmission
What are SYMPTOMS of ACUTE HIV:
The most common manifestations consist of fever, fatigue, Myalgia, skin rash, headache, pharyngitis, cervical adenopathy.
Screenings for HIV:
The CDC recommends to perform routine HIV screening for all persons 13 through 64 years of age in all health care settings. In addition, screening for HIV was recommended for all patients seeking treatment for sexually transmitted infections, pregnant women and for all persons initiating treatment for tuberculosis.
Medications used to treat HIV NAIVE patients include:
Bictegravir/Tenofovir Alafenamide / Emtricitabine
Dolutegravir / Abacavir / Lamivudine - only for HLA B5701 negative individuals and
without chronic hepatitis B virus coinfection
Dolutegravir plus (Emtricitabine or Lamivudine) plus (Tenofovir Alafenamide or Tenofovir
Dolutegravir / Lamivudine - except for individuals with HIV RNA > 500,000 copies/ml,
HBV co-infection or in whom ART is to be started before the results of HIV genotypic testing.
On Jan 2021 the FDA approved a monthly intramuscular injection for people living with HIV who are virologically suppressed on a stable regimen with no history of treatment failure or suspected resistance to either of the medicine approved - CABENUVA : CABOTEGRAVIR extended release injectable suspension co-packaged with RILPIVIRINE extended release injectable suspension.
How can one switch to a 2-drug regimen (less drugs)?
Trials have indicated that the simplification of drug regimens to a dual maintenance therapy may be a useful strategy for - select treatment-experienced patients such as those with a Suppressed HIV RNA for a long period of time, a robust CD4 Cell count and a high genotypic susceptibility score (GSS) for the dual therapy regimen. Your HIV specialty care giver will always determine if you are eligible for the switch. In 2017, the FDA approved fixed-dose regimen Dolutegravir-rilpivirine (JULUCA) for persons with suppressed HIV RNA levels on a stable antiretroviral regimen that they have been taking for at least 6 months.
Is there HOPE for an HIV CURE?
The Aids Clinical Trials Group (ACTG) which is the largest global HIV research network announced the launch of A5386, a phase 1 HIV CURE study evaluating two promising therapies. A5386 will study whether N-803 can control HIV alone or together with combination broadly neutralizing antibodies (bNAbs). In the pre-clinical and clinical research, N-803 exhibited three activities that may help the immune system eliminate HIV reservoirs or control virus rebound while bNAbs neutralize HIV that is produced upon reactivation thus preventing new infections from occurring.