New HIV prevention recommendations combine biomedical and behavioral approaches

July 19, 2014, Emory University

In an innovative approach to HIV prevention, an interdisciplinary group of experts has come together for the first time to lay out a framework of best practices to optimize the role of the clinician in achieving an AIDS-free generation. The guidelines, which will be published online in the Journal of the American Medical Association (JAMA), integrate both cutting-edge biomedical advances and evidence-based behavioral interventions for the care of people living with HIV or at high risk for HIV infection.

The recommendations, developed by an expert volunteer panel assembled by the International Antiviral (formerly AIDS) Society–USA (IAS-USA), are intended as guidelines for clinicians to implement a combined biomedical-behavioral approach to HIV care and prevention. They are based on a comprehensive review of data that was either published or presented at scientific conferences over the past 17 years.

Among the new recommendations is a call for the use of (ART), which suppresses HIV replication and virtually eliminates the risk of transmitting the virus, for all HIV-infected individuals and as pre-exposure prophylaxis (PrEP) for HIV-uninfected individuals at high risk of infection. The guidelines emphasize the integration of behavioral and social interventions—such as psychosocial counseling or treatment for drug dependence—in health care systems to help individuals living with HIV or at high risk for infection to access and remain in high quality HIV care.

"The tools to prevent HIV infection and disease progression are better than ever, but providers need encouragement and support to integrate best practices in communication and counseling with the biomedical measures that can render patients less- and ideally non-infectious," says Jeanne M. Marrazzo, MD, MPH, professor of medicine at the University of Washington; medical director of the Seattle STD/HIV Prevention Training Center; a co-chair of the IAS-USA panel; and corresponding author of the paper.

According to the recommendations, the availability of combination antiretroviral therapy (ART) has changed the lives of millions of individuals living with HIV, transforming HIV from a fatal infection to a manageable chronic disease. But while the incidence of new HIV-1 infections worldwide has decreased by an estimated 33 percent since 2001, it still remains high—approximately 2.3 million new infections occurred in 2012. In the United States alone, approximately 50,000 new infections occur each year—a number that has remained largely unchanged since the 1990s.

"We are at a time where scientific advances in HIV allow us to effectively implement interventions that could stop HIV transmission," says Carlos del Rio, MD, chair of the Department of Global Health at the Rollins School of Public Health at Emory University, professor of medicine at Emory University School of Medicine, co-director of the Emory Center for AIDS Research, co-chair of the IAS-USA Panel, and a member of the IAS-USA volunteer board of directors. "But the success of both biomedical and behavioral HIV prevention measures depends on clinicians' ability and willingness to implement them."

"These guidelines provide a practical, science-based approach that any clinician can implement," says David Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and a co-chair of the IAS-USA Panel. "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."

The panel's recommendations include the following:

  • All adults and adolescents should be tested at least once for HIV, with repeated testing for those at increased risk of acquiring HIV.
  • Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if infection is suspected.
  • Individuals diagnosed with HIV should be linked to care for timely initiation of antiretroviral therapy (ART).
  • Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) should be included in the care of HIV-infected individuals.
  • Uninfected persons at high risk of HIV infection should be prioritized for interventions such as pre-exposure prophylaxis (PrEP) and individualized counseling on risk reduction.
  • Daily emtricitabine/tenofovir disoproxil fumarate is recommended as PrEP for persons at high risk for HIV based on recent diagnosis of STIs, use of injection drugs or shared needles, or recent use of post-exposure prophylaxis; ongoing use of PrEP should be guided by regular risk assessment.
  • For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically-assisted therapies, including opioid agonists and antagonists). Low-threshold detoxification and drug cessation programs should be made available.
  • Post-exposure prophylaxis (PrEP) is recommended and should be initiated as soon as possible for all persons exposed to HIV from a known infected source.

The recommendations note that while implementing them may present structural, economic, or political challenges, the benefits should be substantial in preventing disease progression, promoting the gain of healthy life years and preventing new HIV infections.

Explore further: Do men who have sex with men underestimate their HIV risk and miss out on preventive PrEP?

Related Stories

Do men who have sex with men underestimate their HIV risk and miss out on preventive PrEP?

June 23, 2014
Men who have sex with men (MSM) have a disproportionately high risk of acquiring HIV, and unprotected sex between men accounts for most new HIV diagnoses in the U.S. Yet this population tends to underestimate their HIV risk ...

Herpes virus infection drives HIV infection among non-injecting drug users in New York

June 28, 2014
HIV and its transmission has long been associated with injecting drug use, where hypodermic syringes are used to administer illicit drugs. Now, a newly reported study by researchers affiliated with New York University's Center ...

CDC urges anti-HIV pill for people at high risk of infection

May 15, 2014
(HealthDay)—People deemed to be at high risk for contracting HIV, the virus that causes AIDS, should take anti-HIV medicines that seem to cut transmission risk, the U.S. Centers for Disease Control and Prevention announced ...

WHO warns HIV 'exploding' among gay men, urges preventive drugs

July 11, 2014
HIV infections are rising among gay men in many parts of the world, the World Health Organization warned Friday, urging all men who have sex with men to take antiretroviral drugs to prevent infection.

US backs expanded AIDS therapy for prevention

May 16, 2014
US health authorities are recommending the daily use of anti-retroviral medication to prevent HIV infection for high-risk groups.

HIV transmission networks mapped to reduce infection rate

June 6, 2014
Researchers at the University of California, San Diego School of Medicine have mapped the transmission network of human immunodeficiency virus (HIV) in San Diego. The mapping of HIV infections, which used genetic sequencing, ...

Recommended for you

Researchers find latent HIV reservoirs inherently resistant to elimination by CD8+ T-cells

January 22, 2018
The latest "kick-and-kill" research to eliminate the HIV virus uncovered a potential obstacle in finding a cure. A recent study by researchers at the George Washington University (GW) found that latent HIV reservoirs show ...

HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection

January 18, 2018
A first-of-its-kind study has found that the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is higher in the vaginal tract than in the blood stream during early infection. This finding, published in PLOS ...

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.