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