Week 8 Biomedical Prevention

Continuum

"a coherent whole characterized as a collection, sequence, or progression of values or elements varying by minute degrees"

Truvada and Descovy

Both are nucleoside analog reverse transcriptase inhibitors (NRTI)▪ Must be taken every day to be built up in the system enough to prevent all replication if exposure occurs

PrEP initially met resistance because:

Claimed HIV experts thought PrEP was ineffective public health intervention. Many though it wasnt possible

Serodiscordant

Couple with one HIV-positive and one HIV-negative partner

Social and psychological benefits of prep

Decreased anxiety▪ Increased communication and disclosure▪ Increased intimacy and trust▪ Increased sense of community▪ Increased self-efficacy▪ Increased sexual pleasure and intimacy

Side effects of prep

GI effects (nausea), Small change (~1%) in bone density, small % have kidney issues, Women need higher doses.

Apretude/Cabotegravir

Injectable, once every two months.▪ Significantly better at preventing HIV than Truvada as PrEP, but it is more expensive

What are some of the Key barriers to Healthcare

Limited insurance, limited healthcare services, lack of health education, social or cultural discomfort.

Who does the CDC think should take PREP

Not for everyone, for people high risk of coming in contact with HIV, if youve recently had an STD, and if your partner has HIV

Increasing STIs and risk-taking?

PrEP users have high rates of sexually transmitted infections in two US PrEP studies

PrEP

Pre-exposure Prophylaxis

Descovy

The new prep drug. emtricitabine/tenofoviralafenamide, non-inferior to truvada, slightly less bone density and kindey problem

3 FDA-approved drugs for PrEP

Truvada, Descovy, and Cabotegrivir

PrEP on Demand

Truvada/PrEP provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed

HIV Prevention Continuum

a comprehensive, cyclical HIV- prevention model ▪ Starts with testing negative for HIV ▪ Then: risk assessment, prevention services, adherence support, and back to testing

Structural

address social, economic, cultural factors adding to risk & vulnerability

HIV Care Continuum

aka "HIVtreatment cascade

Blood viral load

associated with the risk of sexual HIV transmission

What was AIDS Healthcare Foundation's executive director Michael Weinsteins reason for not liking prep

claimed truvada was a sex drug

Behavioral

discourage risky behaviors & reinforce protective ones, by addressing knowledge, attitudes, skills, and beliefs

Biomedical

medical and public health approaches to block infection, decrease infectiousness & susceptibility

GI effects (nausea)

more commonin those receiving PrEP, < 10%primarily in the first month

Stages of HIV medical care

people living with HIV go through from diagnosis to viral suppression

PEP

post-exposure prophylaxis

Opposites Attract study

studied 12,000 condomless sex acts between sero-discordant partners: no infection

PARTNER2

study of mixed-HIV-status gay male couples

U=U

treatment as prevention or undetectable = uninfectious

Virally suppressed

under 200copies/ml

Undetectable

under 40 (or 50)copies/ml