HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel
- PMID: 25038358
- PMCID: PMC6309682
- DOI: 10.1001/jama.2014.7999
HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel
Erratum in
- JAMA. 2014 Aug 13;312(6):652
- JAMA. 2014 Jul 23-30;312(4):403
Abstract
Importance: Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings.
Objective: To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings.
Data sources, study selection, and data synthesis: Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus.
Results: Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible.
Conclusions and relevance: Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
Conflict of interest statement
Conflict of Interest Disclosures:
All authors have completed and submitted the ICMJE form for Disclosure of Potential Conflicts of Interest. Disclosure information represents the previous 3 years (updated May 20, 2014).
Dr Marrazzo has served as a consultant to Merck and Astra-Zeneca; Dr del Rio has no conflicts to disclose; Dr Holtgrave’s institution, The Johns Hopkins Bloomberg School of Public Health, has received research funds from Johnson and Johnson and Female Health Company; Dr Cohen has served as a consultant to Janssen Global Services and Roche Molecular Systems, Inc; Dr Mayer’s institution, Fenway Health, has received research grants from Gilead Sciences and Merck; Dr Montaner’s institution, BC-Centre for Excellence in HIV/AIDS at Providence Health Care and the University of British Columbia, has received research grants from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare; Dr Kalichman has no conflicts to disclose; Dr Wheeler has no conflicts to disclose; Dr Grant has served as a consultant to Siemens Healthcare and ViiV Healthcare, and his institution, the University of California San Francisco, has received support from Gilead Sciences for travel, accommodation, and meeting expenses; Dr Grinsztejn has no conflicts to disclose; Dr Kumarasamy has no conflicts to disclose; Dr Shoptaw has no conflicts to disclose; Dr Walensky has no conflicts to disclose; Dr Dabis has no conflicts to disclose; Dr Sugarman has no conflicts to disclose; Dr Benson’s spouse has received research support from Bristol-Myers Squibb and Boehringer Ingelheim Pharmaceuticals, Inc, and has served as a scientific advisor to CytoDyn and Merck & Co, Inc, as a scientific advisory board member for Gilead Sciences, Inc, GlobeImmune, Inc, and Monogram Biosciences, and as a member of data monitoring committees for Axio and Gilead Sciences, Inc. He has stock in GlobeImmune, Inc.
Dr Marrazzo had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Figures
Comment in
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Integrating HIV prevention into practice.JAMA. 2014 Jul 23-30;312(4):349-50. doi: 10.1001/jama.2014.8606. JAMA. 2014. PMID: 25038352 No abstract available.
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