Behavioral strategies to reduce risk
In the era of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and treatment as prevention, behavioural methods of risk reduction – including condom use, clean injecting equipment, HIV serosorting, strategic positioning, and negotiated safe practices with sexual partners– retain their importance in preventing HIV transmission (Box 11.1). However, some vulnerable individuals, particularly some cis-gender and […]
Improving medication adherence
Medication adherence is critical to achieving the maximum prevention benefit of pre-exposure prophylaxis (PrEP) and reducing the risk of selecting for a drug-resistant virus in the event of human immunodeficiency virus (HIV) acquisition 1, 2. In randomised, blinded, placebo-controlled trials of PrEP, adherence varied 1 and was lower among cis-gender women in some studies 3, […]
References
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Post-exposure prophylaxis after non-occupational and occupational exposure to HIV: Australian National Guidelines (Second edition). August 2016. Available at: https://ashm.org.au/HIV/PEP/ (last accessed 18 July 2019).
HIV non-occupational post-exposure prophylaxis and pre-exposure prophylaxis
People not receiving human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) who seek care within 72 hours after an isolated sexual or injection-related HIV exposure should be evaluated for the need for non-occupational post-exposure prophylaxis (nPEP) 1. nPEP may also be considered where an individual receiving PrEP reports being poorly adherent and seeks care within 72 […]
References
Kirby HIV in Australia: annual surveillance short report 2018. Sydney: Kirby Institute, UNSW Sydney;2018. NSW Ministry of NSW HIV Strategy 2016–2020 Quarter 1 2019. Data Report. Available at: https://www.health.nsw.gov.au/endinghiv/Publications/q1-2019-nsw-hiv-data-report.pdf (lastaccessed 2 September 2019). Queensland Pre-exposure Prophylaxis Demonstration Project Expansion (QPrEPd) Monitoring and EvaluationAnnual Report Number 1 Available at: https://www.comeprepd.info/wp-content/ uploads/2018/04/qprepd-first-report.pdfaccessed September 10th 2019 (last accessed 11 September […]
Adolescent minors
As a part of primary health care, HIV screening should be discussed with all adolescents who are sexually active, or have a history of injecting drug use. Parental or guardian involvement in an adolescent’s health care is often desirable, but is sometimes contraindicated for the safety of the adolescent, and can compromise full disclosure. Clinicians […]
Patients with chronic active HBV infection
PrEP and Chronic Hepatitis B The risk of HBV infection is significantly reduced in people who use TD*/FTC for HIV PrEP, with or without HBV vaccination due to these drugs having dual HIV and Hepatitis B activity.5-7 All people who test positive for hepatitis B surface antigen (HBsAg) should be evaluated for the need for […]
Patients with chronic renal failure
Patients without HIV infection and with established chronic renal failure, e.g. with estimated glomerular filtration rate (eGFR) that is stably less than 60 mL/min/1.73 m2 should not be prescribed PrEP. The only PrEP regimen proven effective to date and approved by the TGA is TD*/FTC, which is not indicated for those with chronic renal failure […]
Breastfeeding
Although experience with PrEP during breastfeeding is lacking, there is substantial experience with the use of TD*/FTC during the breastfeeding period by HIV-positive women taking TD*/FTC based antiretroviral therapy. TD* and FTC are secreted in breast milk, although at much lower concentrations (0.3 and 2%, respectively), of the levels achieved with the doses recommended for […]
Women taking PrEP during conception, pregnancy and breastfeeding
Conception in serodiscordant couples Women without HIV infection who have sexual partners with documented HIV infection are at risk of HIV acquisition during natural attempts to conceive (i.e. without a condom) if their HIV-positive partner has a detectable or variably detectable plasma viral load. Providers should discuss with their patients the available information about the […]