New HIV Care Includes Medical and Behavioral Treatment

Recently released HIV prevention guidelines combine medical and behavioral approaches

(RxWiki News) Human immunodeficiency virus (HIV) is a sexually transmitted disease that can be deadly. HIV infection often goes undetected in patients who do not seek care. However, new research says that there may be new ways to use HIV care so that the virus becomes manageable.

An international panel of HIV experts recently released a set of recommendations meant to help guide doctors through HIV care and prevention for adults and teenagers using a combination of medical and behavioral approaches.

The authors of the guidelines believe that the benefits of a combined medical and behavioral approach will significantly help prevent disease progression, promote the gain of healthy years of life and prevent new HIV infections for people living with the virus or people who are at high risk for getting HIV.

"Get tested regularly for HIV."

The lead author of these guidelines was Jeanne M. Marrazzo, MD, MPH, from the University of Washington in Seattle, Washington.

HIV is a virus that attacks the immune system by replicating itself over and over again in the body's white blood cells (aka the body's defense mechanism).

The authors reviewed data from 250 previously published studies on HIV prevention in adults and teenagers that had been presented at scientific conferences within the last 17 years.

When determining these recommendations, Dr. Marrazzo and team emphasized that providing prevention in care requires a combination of medical and behavioral approaches.

"We are at a time where scientific advances in HIV allow us to effectively implement interventions that could stop HIV transmission," explained co-author Carlos del Rio, MD. "But the success of both biomedical and behavioral HIV prevention measures depends on clinicians' ability and willingness to implement them."

The main medical approach used in the recommendations was antiretroviral therapy (ART)—a treatment that uses antiretroviral drugs to suppress the HIV virus and stop the progression of disease.

According to the authors, the widespread availability of ART has changed the nature of the virus from a deathly infection to a manageable chronic disease. However, almost 2.3 million people were infected with HIV in 2012 around the world despite the incidence of the virus having dropped by 33 percent since 2001.

Pre-exposure prophylaxis (PrEP) is also a medical approach mentioned in the recommendations that is a preventive measure for people who may be at high risk for getting the virus because of exposure through sex or injection drug use. PrEP involves taking medicines every day that help keep the virus from establishing a permanent infection.

The behavioral approaches considered in the recommendations include treatment and counseling for drug dependence, or psychological counseling.

The authors agreed on the following recommendations:

  • All adults and teenagers should be tested for HIV at least once and should continue to get tested if they are at high risk for getting HIV.
  • Doctors should be aware of the possibility of acute HIV infection (the period of time immediately following infection of HIV when the virus replicates itself rapidly resulting in an extremely high amount of HIV in the blood) and immediately perform diagnostic testing if an infection is suspected.
  • Patients who are diagnosed with HIV should immediately be connected to care so they can start ART as soon as possible.
  • Support for keeping up with care, individualized risk assessment and counseling, assistance with partner notification and periodic screening for common sexually transmitted diseases (STD) should be provided to HIV-positive people.
  • HIV-negative people who are at high risk for infection should be given PrEP and be counseled on how to reduce their risk.
  • Daily doses of emtricitabine/tenofovir disoproxil fumarate is recommended as PrEP for people who are deemed high-risk based on recent diagnosis of STDs, use of injection drugs or shared needles or recent use of PrEP; continuous use of PrEP should be guided according to a regular risk assessment.
  • Harm reduction services such as needle and syringe exchange programs or supervised injection should be provided to people who inject drugs, and detoxification and drug rehabilitation programs should be made available as well.
  • PrEP initiation is recommended as soon as possible for all people exposed to HIV from a known infected source.

"These guidelines provide a practical, science-based approach that any clinician can implement," concluded co-author David Holtgrave, PhD. "They are designed to promote the integration of the best available services—both behavioral and biomedical—and to create a clear pathway to access these services and realize their full benefit."

These guidelines were published on July 19 in JAMA.

The International Antiviral Society-USA provided funding.

Review Date: 
July 19, 2014