A new era of prevention

BY ANGELA NUNNERY, M.D., Board certified family physician

An estimated 1.2 million people are living with a viral infection for which there is no cure. It is an epidemic resulting in some 50,000 new cases of infection every year.

Unlike other viruses, the human body cannot rid itself of the human immunodeficiency virus (HIV). Once infected, the victim has it for life, according to the Center for Disease Control & Prevention. Without the availability of a cure, safe and effective new approaches to prevent HIV are urgently needed to reduce the toll this disease is taking on Americans.

And while HIV treatment options have improved dramatically in recent years, the U.S. Preventative Task Force recommends clinicians screen adolescents and adults between 15 and 65 years of age for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened, as should pregnant women.

In a recent infectious disease symposium conducted by the National Medical Association, Dr. Eugene McCray, director of the Division of HIV/AIDS Prevention at CDC, addressed key issues related to avoidance.

“There is strong evidence from recently completed studies that daily oral preexposure prophylaxis (PrEP) with a combination of tenofivir disoproxil furmarate and emtricitabine (Truvada) significantly reduces the risk of HIV acquisition among multiple high risk populations, including men who have sex with men (msm), heterosexual women and men − including those in HIV discordant couples – and people who inject drugs.”

It is of primary importance to follow the CDC’s recommendation of taking a sexual history of all adult and adolescent patients. The CDC has recognized that the sexual history is often deferred among clinicians for numerous reasons including urgent care issues, anticipated patient discomfort or provider issues.

The CDC reports that a patient’s risk of acquiring HIV is determined by several factors, including the likelihood that a sexual partner has HIV infection and the frequency of specific sexual practices, such has unprotected anal intercourse. Once the risk of HIV infection is assessed, physicians must discuss the use of condoms, behavioral interventions and the use of PrEP.

Of note, there is a reported 80% reduction in acquiring HIV with consistent use of a condom in heterosexual couples. Therefore, if the patient is not consistent with the use of condoms, the physician should present the patient with the possible consideration of PrEP treatment.

It was stressed in the symposium that patients should be tested for HIV prior to therapy, as the treatment for these patients is different. In addition, knowledge of compliance of therapy in the concordant HIV positive partner is needed.

We are in a war against HIV. We must be diligent in identifying at-risk patients in our practice and offer to them potentially lifesaving Pre-Exposure Prophylaxis.