What are the most effective methods for preventing HIV infection?

From the Guidelines

The most effective methods for preventing HIV infection include consistent use of condoms, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and regular testing, as recommended by the International Antiviral Society-USA panel in 2024 1.

Key Prevention Methods

• Condoms, when used correctly during every sexual encounter, provide excellent protection against HIV transmission.
• PrEP involves taking antiretroviral medication daily by HIV-negative individuals at high risk; the most common regimen is Truvada (emtricitabine 200mg/tenofovir disoproxil fumarate 300mg) or Descovy (emtricitabine 200mg/tenofovir alafenamide 25mg) taken once daily, which reduces infection risk by over 90% when taken consistently 1.
• For those potentially exposed to HIV, PEP consists of a 28-day course of antiretroviral medications (typically a three-drug regimen including integrase inhibitors) that must be started within 72 hours of exposure, preferably sooner 1.
• Regular HIV testing every 3-6 months is recommended for those at higher risk to ensure early detection.

Additional Prevention Strategies

• Not sharing needles or drug injection equipment
• Treating other sexually transmitted infections promptly
• For pregnant women with HIV, taking antiretroviral therapy to prevent transmission to the baby These methods work by either creating physical barriers to the virus, reducing the amount of virus in the body of HIV-positive individuals, or providing medication that prevents the virus from establishing infection in HIV-negative individuals.

Important Considerations

• PrEP should be considered for anyone from a population whose HIV incidence is at least 2% per year or HIV-seronegative partners of HIV-infected persons who do not have viral suppression 1.
• Daily (rather than intermittent) TDF/emtricitabine is the recommended PrEP regimen 1.
• Tenofovir disoproxil fumarate–based PrEP is not recommended for individuals with osteopenia or osteoporosis or a creatinine clearance rate of less than 60 mL/min 1.

From the FDA Drug Label

Tenofovir disoproxil fumarate is a prescription medicine that is used to: treat HIV-1 infection when used with other anti-HIV-1 medicines in adults and children 2 years of age and older who weigh at least 22 pounds (10 kg). The most effective method for preventing HIV infection is not explicitly stated in the provided drug labels. However, tenofovir disoproxil fumarate is used to treat HIV-1 infection when used with other anti-HIV-1 medicines.

• It is essential to follow the recommended treatment regimen and take the medication as prescribed by a healthcare provider.
• Additionally, pre-exposure prophylaxis (PrEP), which involves taking tenofovir disoproxil fumarate daily, can help prevent HIV infection in high-risk individuals 2. It is crucial to note that the provided drug labels do not directly answer the question about the most effective methods for preventing HIV infection. Therefore, the information provided is limited to the context of treating HIV-1 infection with tenofovir disoproxil fumarate.

From the Research

Effective Methods for Preventing HIV Infection

The most effective methods for preventing HIV infection include:

• Pre-exposure prophylaxis (PrEP) with daily dosing of tenofovir disoproxil fumarate (TDF)/emtricitabine, which has been shown to reduce HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 3
• Consistent use of latex condoms, which are 90 to 95% effective in preventing HIV transmission when used correctly and consistently 4
• Treatment as prevention, which involves the use of antiretroviral therapy to suppress the virus and prevent transmission to others

PrEP Regimens

Different PrEP regimens have been studied, including:

• Daily TDF/emtricitabine, which has been shown to be safe and well-tolerated, with an efficacy of over 90% when used consistently 3
• Two-dose emtricitabine/tenofovir alafenamide plus bictegravir, which has been shown to protect macaques against SHIV infection with over 95% per-exposure risk reduction 5
• Long-acting injectable PrEP, which is a guideline-approved dosing approach, but its effectiveness and safety are still being studied 6

Barriers to PrEP Uptake and Persistence

Despite the effectiveness of PrEP, there are several barriers to its uptake and persistence, including:

• Limited access to PrEP, particularly among priority populations 6
• Stigma and discrimination against individuals at risk for HIV infection 6
• Lack of awareness and education about PrEP among healthcare providers and individuals at risk for HIV infection 6
• High cost of PrEP and lack of insurance coverage 6

Recommendations for Condom Use

Healthcare providers' recommendations for condom use vary, but most recommend condom use for individuals with HIV who have viral suppression and for individuals receiving PrEP, despite the evidence that successful treatment or PrEP prevents transmission 7