From the Guidelines
HIV transmission can be prevented through multiple effective strategies, including the use of antiretroviral therapy (ART), pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and the consistent use of barrier methods like condoms. The most recent and highest quality study, published in 2018 in JAMA 1, recommends the use of antiretrovirals for HIV prevention, including treatment as prevention, PrEP, and PEP.
Key Prevention Strategies
- Pre-exposure prophylaxis (PrEP): Daily TDF/emtricitabine is recommended for persons at risk of HIV through sexual exposure (evidence rating AIa) and for people who inject drugs (evidence rating BIa) 1.
- Antiretroviral therapy (ART): Reduces viral load to undetectable levels, making transmission through sex virtually impossible—a concept known as "Undetectable = Untransmissible" (U=U) 1.
- Post-exposure prophylaxis (PEP): A 28-day course of antiretroviral medications can prevent infection if started within 72 hours after potential exposure 1.
- Barrier methods: Consistent use of condoms during sexual activity creates a physical barrier that blocks the exchange of bodily fluids containing the virus.
- Clean equipment: People who inject drugs should use clean, sterile equipment and never share needles or syringes.
- HIV testing: Regular HIV testing is essential for early detection and treatment, which both improves health outcomes and prevents further transmission.
Special Considerations
- Pregnant women: HIV-positive mothers can prevent transmission to their babies through proper ART during pregnancy, delivery, and breastfeeding 1.
- High-risk populations: PrEP is recommended for populations with an HIV incidence above 2% per year (evidence rating AIII) and for HIV-seronegative partners of HIV-infected persons who are not consistently virally suppressed 1.
From the FDA Drug Label
Advise patients to avoid doing things that can spread HIV-1 infection to others. Do not share needles or other injection equipment Do not share personal items that can have blood or body fluids on them, like toothbrushes and razor blades. Do not have any kind of sex without protection. Always practice safe sex by using a latex or polyurethane condom to lower the chance of sexual contact with semen, vaginal secretions, or blood. Do not breastfeed Mothers with HIV-1 should not breastfeed because HIV-1 can be passed to the baby in the breast milk.
To prevent HIV transmission, patients should:
- Avoid sharing needles or other injection equipment
- Not share personal items that can have blood or body fluids on them
- Practice safe sex by using a latex or polyurethane condom
- Not breastfeed if they have HIV-1, as it can be passed to the baby in the breast milk 2
From the Research
HIV Transmission Prevention Methods
HIV transmission can be prevented through various methods, including:
- Consistent and correct use of condoms, which are effective at preventing sexually transmitted HIV infections 3
- Antiretroviral therapy (ART) to prevent HIV transmission, known as treatment as prevention 3
- Pre-exposure prophylaxis (PrEP) with daily dosing of tenofovir disoproxil fumarate (TDF)/emtricitabine, which has been shown to significantly reduce HIV acquisition in high-risk individuals 4, 5
- Postexposure prophylaxis (PEP) with a 3-drug regimen, such as raltegravir, tenofovir DF, and emtricitabine, which has been shown to be safe, tolerable, and effective in preventing HIV infection after high-risk sexual exposures 6
Key Considerations for HIV Prevention
When using these prevention methods, it is essential to consider the following factors:
- Adherence to the prescribed regimen, as efficacy is highly correlated with degree of adherence 5
- Potential side effects, such as nausea, diarrhea, and headache, which are generally mild and self-limited 6
- Drug interactions and pharmacokinetics, which can affect the efficacy and safety of the prevention method 7
- Access to and availability of these prevention methods, particularly for high-risk individuals 4, 5
Benefits of HIV Prevention Methods
The benefits of these prevention methods include: