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5 Use of ART for Prevention of HIV Infection

Treatment as Prevention (TasP)

  • The concentration of HIV in both blood and seminal plasma correlates with the probability of transmission of HIV to a sexual partner.

  • Reducing levels of HIV with ARV therapy decreases the probability of transmission, as confirmed by a RCT (HPTN 052).

  • Treatment as Prevention (TasP) refers to the use of ARV therapy in the infected person and the secondary preventive benefit derived from it.

  • TasP is now accepted to be over 95% effective in the vertical (mother-to-child), sexual and parenteral transmission settings.

  • A powerful synergy has emerged between the recommendations for the treatment of the individual and the public health goal of preventing new HIV infections.

Post-exposure prophylaxis (PEP)

  • The BC-CfE Accidental Exposure Therapeutic Guidelines provide a framework for assessment and management of persons who have been exposed to HIV through blood or body fluids in the workplace or community setting, and in cases of sexual assault.

  • The guidelines include recommendations for:

    • antiretroviral PEP based on assessment of the risk of HIV exposure
    • laboratory testing of the source person
    • post-exposure counseling
    • appropriate monitoring and followup
  • Counseling should be offered to all persons experiencing an exposure event.

  • If there is evidence of a significant risk exposure, prompt initiation of antiretroviral PEP is recommended.

  • In BC, PEP inquiries should be directed to the St. Paul's Hospital Pharmacy

Pre-exposure prophylaxis (PrEP)

  • Data from multiple clinical trials how that tenofovir DF-emtricitabine (Truvada) is safe and effective as PrEP for prevention of HIV infection in high-risk populations.

  • The effectiveness of PrEP has been shown to be directly associated with medication adherence.

  • At this time the use of PrEP is considered a medically acceptable option for selected individuals; however, this approach is not currently publicly funded in B.C. The BC-CfE has provided recommended guidance for the managment of patients taking tenofovir-emtricitabine (Truvada) for PrEP on this page.

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