Providing a person with HIV infection engages with specialist care and achieves sustained HIV suppression with antiretroviral therapy (ART), morbidity is greatly reduced, life expectancy approaches near normal and the chance of onward transmission of HIV is significantly decreased.[2] [3] [4] During 2013, an estimated 1212 people with diagnosed HIV in Australia were not engaged in care.[1] Poor …
Promoting, nurturing and supporting engagement is best realised by providing: support education service coordination. Importantly person-centred approaches need to be adopted to ensure the highest attainable standard of health for people living with HIV and people at risk of HIV acquisition. Person-centred approaches include: centre a person’s autonomy, dignity and rights respect a person’s decisions …
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Contact tracing is an essential part of the management of a person newly diagnosed with HIV but should rarely be the priority in the initial encounter. People with HIV can experience significant discrimination and rejection. There are implications for employment, relationships, insurance and immigration unless there is a possibility of providing post-exposure prophylaxis (PEP) to …
King J, McManus H, Kwon A, Gray R, & McGregor S. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2023. Sydney: The Kirby Institute UNSW: 2023. Available at https://www.kirby.unsw.edu.au/sites/default/files/documents/Annual-Surveillance-Report-2023_HIV.pdf (accessed 11 June 2024). Mocroft A, Vella S, Benfield TL, et al. Changing patterns of mortality across Europe in patients infected with …
Gilda Tachedjian Burnet Institute, Melbourne, VIC Last reviewed: August 2019 Background Microbicides are chemical entities that can be formulated in gels, films, tablets, capsules or intravaginal rings (IVR) for application to the vagina or rectum to prevent the transmission of HIV and other sexually transmissible infections (1, 2). While male condoms are known to protect …
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Despite major advances in HIV treatment and prevention, HIV infection remains a significant global health threat including in women. In 2017, around 7000 adolescent girls and young women became infected with HIV every week (9). Most of this burden is in sub-Saharan Africa where around 3 out of 4 new HIV infections occur in 15-19 …
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IVRs comprising a silicone matrix that releases the ARV drug dapivirine, over one month is the only microbicide evaluated in a phase III clinical trial demonstrating efficacy (27 and 31%) in preventing HIV transmission in women as determined in The Ring Study and ASPIRE studies (11, 12). The dapivirine ring is currently being evaluated in …
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The microbicide field has been overtaken by oral PrEP comprising of ARVs (i.e. tenofovir and emtricitabine [Truvada]) normally used for HIV treatment (see Biomedical Prevention Section). Several clinical trials (iPrEX, Partners PrEP, TDF2, PROUD) have demonstrated the efficacy of oral daily PrEP in MSM and high-risk heterosexual men and women including serodiscordant couples (13-15). The …
While the TDF2 (15) and Partners PrEP (14) studies indicate that oral PrEP can work in women, other trials in high-risk women (FEM-PrEP and VOICE) showed no efficacy (20, 21). This lack of efficacy was largely attributed to poor adherence (22). However, other factors such HIV subtype exposure, mode of transmission, and the percent of …
There are exciting advances in the development of long-acting injectable and implants to deliver sustained levels of ARV drugs (25, 26). However, like oral PrEP these modalities deliver the drug systemically, which may discourage their use. Major advantages of these delivery strategies are that dosing is discrete and independent of coitus, which should maximise adherence …