New HIV guideline outlines cost-effective prevention strategies for high-risk people

November 27, 2017

A new Canadian guideline outlines how new biomedical strategies to prevent HIV infection can best be used in high-risk populations both before and after exposure to the virus. The guideline, published in CMAJ (Canadian Medical Association Journal)http://www.cmaj.ca/lookup/doi/10.1503/cmaj.170494, applies to adults at risk of HIV infection through sexual activity or injection drug use.

"The large financial cost of HIV infection and the young age of those newly diagnosed (most new cases occur in those aged 30 to 39 years) underscore the economic and social importance of preventing new infections," writes Dr. Darrell Tan, an infectious diseases physician and researcher at St. Michael's Hospital, Toronto, Ontario, with coauthors.

Key strategies, in line with international guidelines, include pre-exposure prophylaxis (PrEP), which refers to the regular use of anti-HIV medications beginning before an exposure occurs, and nonoccupational postexposure prophylaxis (nPEP), which involves taking a course of antiretroviral medications after a sexual or drug use-related exposure to HIV.

The guideline, with easy-reference boxes outlining practical advice for prevention, is aimed at clinicians in primary care, infectious diseases, emergency medicine, nursing, pharmacy and other disciplines. Policy-makers may also find it useful in setting health care policy. The Biomedical HIV Prevention Working Group of the CIHR Canadian HIV Trials Network developed the guideline with a panel of 24 experts from diverse disciplines.

More than half (54%) of all new infections in Canada occur in gay, bisexual and other men who have sex with men, a group with an estimated risk of infection 131 times higher than other men. Injection drug users are estimated to be 59 times more likely than nonusers to acquire HIV. People from countries with endemic HIV are 6.4 times more likely to become infected, and Indigenous people are also at higher risk (2.7 times), compared with the general population in Canada.

The authors note that the medications used as PrEP and nPEP are generally very safe and effective, although these regimens may not be right for all people at increased HIV risk, because of personal preferences or risk of rare drug toxicities.

Health economic analyses indicate that targeting PrEP to high-risk populations is cost-effective in terms of health care spending.

"To date, medication costs have also restricted the feasibility and acceptability of these strategies," write the authors. "However, the recent introduction of generic TDF/FTC [the anti-HIV medication approved for use as PrEP in Canada and a major component of all nPEP regimens] and the increasing availability of public drug coverage for PrEP in Canada may have substantial effects on their uptake."

This Canadian guideline is generally consistent with international guidelines from the United Kingdom, United States and Australia.

"We hope that this guideline will contribute to reducing HIV incidence in Canada by improving the quality of care, increasing access to care, reducing inappropriate variation in practice and promoting the rigorous evaluation of biomedical prevention strategies nationwide," the authors conclude.

Development of the guideline was funded by the Canadian Institutes of Health Research and supported in-kind by the CIHR Canadian HIV Trials Network.

"Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis" is published November 27, 2017.
-end-
Podcast link: https://soundcloud.com/cmajpodcasts/170494-guide

Canadian Medical Association Journal

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.