“Antiretroviral medications are recommended for post-exposure 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” (p. 1)
Dr. Robert Grant, of Gladstone Institutes. University of California, San Francisco, and San Francisco AIDS Foundation, and Dr. Dawn K. Smith, of the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, co-wrote “Integrating Antiretroviral Strategies for Human Immunodeficiency Virus Prevention: Post- and Pre-Exposure Prophylaxis and Early Treatment.” Drs. Smith and Grant suggest best practices for HIV testing, PEP, PrEP, and early treatment of HIV “based on research evidence and existing normative guidelines.”
“There is growing consensus that antiretroviral medications have an important role to play in preventing the transmission and acquisition of human immunodeficiency virus (HIV)…” (p. 1)
Drs. Smith and Grant present the guidelines for PEP, efficaciousness, regimens available, and barriers to uptake for non-occupational PEP use.
“Nonoccupational PEP use has been low in most settings, with barriers including a lack of awareness among potential users, difficulty identifying exposures or denial of their risk, the requirement that action be taken within hours up to 2–3 days of exposure, and a lack of nonoccupational PEP awareness among healthcare providers” (p. 1)
Then they present the guidelines, consumer demand, barriers to faster uptake, and coverage options, issues, and solutions for PrEP.
“Consumer demand for PrEP increased 332% in the United States in 2014” (p. 2)
Drs. Smith and Grant present evidence on the benefits of early treatment and the challenges involved in engaging patients in testing, treatment, and care.
“Antiretroviral treatment of HIV infection prolongs life, restores health, and significantly reduces onward HIV transmission” (p. 2)
The section “A Common Entry Point: Human Immunodeficiency Virus Testing,” discusses different barriers and motivators for HIV testing.
Drs. Smith and Grant provide evidence and guidelines for detecting acute HIV and for “choosing and transitioning among antiretroviral strategies” (p. 3-5). A helpful figure is found on the top of page 3, the “integrated post-exposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment transition algorithm.”
In conclusion, “Transitions from PEP to PrEP and from prophylaxis to treatment can be clinically straightforward, with minimal risks and substantial benefits, including continuous HIV prophylaxis and earlier initiation of treatment” (p. 5). There needs to be a multi-pronged approach to prevention and treatment, and there are barriers (mostly lack of knowledge) that need to be broken down to get to zero HIV transmissions, deaths, and stigma.