Prevention Methods In HIV

PHARMACEUTICALS:
Some commonly considered pharmaceutical interventions for the prevention of HIV might include the use of the following:
  • microbicides for sexually transmitted diseases
  • pre-exposure prophylaxis
  • post-exposure prophylaxis
  • circumcision (see also Circumcision and HIV)
  • antiretroviral drugs to reduce viral load in the infected
  • condoms, and
  • low dead space syringes
SOCIAL STRATEGIES:
Social strategies do not require any drug or object to be effective, but rather require persons to change their behavior in order to gain protection from HIV. Some social strategies which people consider include the following:

  • sex education
  • LGBT sex education
  • needle-exchange programmes
  • safe injection sites
  • safe sex
  • serosorting
  • sexual abstinence
  • immigration regulation
  • Community education behavioral change is aimed at AIDS control in India 
SEXUAL CONTACT:
  • Consistent condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term. 
  • The use of the spermicidenonoxynol-9 may increase the risk of transmission due to the fact that it causes vaginal and rectal irritation.
  • A vaginal gel containing tenofovir, a reverse transcriptase inhibitor, when used immediately before sex, reduce infection rates by approximately 40% among African women.
  • World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007. 
  • sexual education provided at school may decrease high risk behavior. 
PRE-EXPOSURE:
  • Early treatment of HIV-infected people with antiretrovirals protected 96% of partners from infection.
  • Targeted intervention for HIV is done for Sex workers , Migrant laborers ,Homosexual men, Truckers , IV drug users , Street children
  • Pre-exposure prophylaxis with a daily dose of the medications tenofovir with or without emtricitabine is effective 
  • Universal precautions within the health care environment
  • Intravenous drug use is an important risk factor and harm reduction strategies such as needle-exchange programmes and opioid substitution therapy appear effective in decreasing this risk.
  • Needle exchange programs (also known as syringe exchange programs) are effective in preventing HIV among IDUs as well as in the broader community. 
  • Pharmacy sales of syringes and physician prescription of syringes have been also found to reduce HIV risk. 
  • Supervised injection facilities are also understood to address HIV risk in the most-at-risk populations. 
  • Multiple legal and attitudinal barriers limit the scale and coverage of these "harm reduction" programs 
  • For contaminated medical instruments 2 % solution of glutaraldehyde is used.
  • Put the blood contaminated dressing material directly in an appropriate bag and send for incineration
  • If a patient of Hemophilia to be taken for dental extraction patients should be screened for HIV
POST EXPOSURE
  • A course of antiretrovirals administered within 48 to 72 hours after exposure to HIV positive blood or genital secretions is referred to as post-exposure prophylaxis. 
  • The use of the single agent zidovudine reduces the risk of subsequent HIV infection fivefold following a needle stick injury.
  • Treatment is recommended after sexual assault when the perpetrators is known to be HIV positive but is controversial when their HIV status is unknown. Current treatment regimes typical use lopinavir/ritonavir and lamivudine/zidovudine or emtricitabine/tenofovir and may decrease the risk further
  • The duration of treatment is usually four weeks and is associated with significant rates of adverse effects (for zidovudine ~70% including: nausea 24%, fatigue 22%, emotional distress 13%, headaches 9%).
FOLLOW- UP-CARE:
  • Strategies to reduce recurrence rates of HIV have been successful in preventing reinfection. 
  • Treatment facilities encourage those previously treated for HIV return to ensure that the infection is being successfully managed. 
  • New strategies to encouraging re-testing have been the use of text messaging and email.
  • These methods of re-call are now used along with phone calls and letters.
MOTHER TO CHILD:
  • Methods to prevent vertical transmission
  • a) Antiretroviral prophylaxis
  1. Vertical transmission can be prevented substantially by giving antiretroviral therapy to mother and early prophylaxis to newborn.
  2. b) Caesaren delivery -
  3. Elective caesarean section reduces the risk of transmission by 50% in women with or without ZDV treatment.
  4. c) Breast feeding -
  5. Because breast milk can carry the virus, breast feeding by HIV infected mothers is contraindicated.
VACCINATION:
  •  Vaccine RV 144 published in 2009 found a partial efficacy rate of ~30%
Exam Question
  • For contaminated medical instruments 2 % solution of glutaraldehyde is used.
  • Strategies effective in preventing mother to child transmission of HIV are Antiretroviral prophylaxis,Caesaren delivery & avoiding Breast feeding
  • Put the blood contaminated dressing material directly in an appropriate bag and send for incineration
  • Target strategies in preventing the HIV transmission include Education, Treatment of STD & use of Condoms
  • Targeted intervention for HIV is done for Sex workers , Migrant laborers ,Homosexual men, Truckers , IV drug users , Street children
  • Community education behavioral change is aimed at AIDS control in India
  • Universal (standard) precautions to be observed by surgeons for the prevention of hospital acquire HIV infection include Wearing gloves and other barrier precaution,Washing hands on contamination & Handling sharp instruments with care
  • If a patient of Hemophilia to be taken for dental extraction patients should be screened for HIV
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