the Pre-exposure prophylaxis (Preparatory school) and Post-exposure prophylaxis (Beep) are strategies that include pharmaceutical Antiretrovirals To prevent Infection via HIV (HIV).
In the case of pre-exposure prophylaxis (PrEP), it is used before possible exposure to the virus, while post-exposure prophylaxis (PEP) is used after a risk situation. both of them They seek to prevent the virus from establishing itself in the human body.
In a frame World AIDS Daywhich has been commemorated on December 1st every year since 1988 with the support of United NationsToday, a panel of experts published a guide with Recommendations and 10 practical guidelines To facilitate access to PrEP and PEP for teens and adults facing risky situations.
The guide was published in the magazine Journal of the Canadian Medical Association. Today, 40.8 million people are living with HIV worldwide, and 1.3 million new infections will occur in 2024, and 9.2 million people still do not have access to treatmentAccording to the latest program report UNAIDS.
By publishing the guide, we seek to develop prevention measures on a broader, simpler and more personalized basis.
Coordination was responsible for Darryl H. S. Tanan infectious disease specialist at St. Michael’s Hospital, in collaboration with Canadian Institute for Health Research and Canadian HIV Clinical Trials Network.
They want to reduce new cases of people with HIV by combining prevention with early access to drug options.
The aim is to remove administrative and social hurdles so that those who could benefit from these treatments can access them without delay or additional requirements.
The guide is designed as a clear reference for health professionals and for the public seeking verified information.
The authors of the post shared these good practices:
- Providing PrEP and PEP counseling to all sexually active people, including adolescents and injection drug users, with positive information.
- Allow PrEP to be prescribed to any adult or teen who requests it.
- Assess the risk of HIV infection at each visit and suggest primary prophylaxis for those who may benefit.
- If the specific gender or gender identity is not clear, health workers should be instructed to make the reference according to the anatomy and condition of the patient and their partners.
- Indicate post-exposure only if there is a real risk and when the source person is capable of transmitting HIV.
- Get an HIV test before giving post-exposure prophylaxis, without delaying treatment.
- Do not prescribe post-exposure prophylaxis if the source person is HIV-negative, the condition is unknown in the general population or the HIV-positive person has an undetectable viral load.
- In questionable situations, make the decision together with the patient and never delay access to treatment.
- Begin prophylaxis immediately after exposure and continue for 28 days.
- Authorities, organizations and scientific societies should be involved in promoting and monitoring pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
Experts also identified which medications should be indicated Preparatory school We are:
- Tenofovir disoproxil fumarate/emtricitabine: The daily regimen, in tablet form, is the preferred option for most people without HIV.
- Tenofovir alafenamide/emtricitabine: It may be taken into consideration in specific cases, for example, for people with kidney or bone density problems.
- Long-acting cabotegravir: Intramuscular injection every two months. They state in the guide: “We recommend CAB-LA 600 mg as a PrEP option.”
Meanwhile, the medications that should be used in cases of PEP are:
- Bictegravir/tenofovir alafenamide/emtricitabine
- Dolutegravir plus tenofovir disoproxil fumarate/emtricitabine
Both regimens should be started as soon as possible after exposure (maximum 72 hours) and maintained for 28 days.
These medicines have already proven their effectiveness and safety in preventing HIV in people with different characteristics and needs, according to the updated guideline recommendations.
In conversation with informationThe doctor Marcelo LosoHead of the Department of Emerging Diseases and principal researcher at the university’s research unit Ramos Mejia Hospital Professor of Pharmacy at the College of Medicine University of Buenos Aires (UBA) in ArgentinaComment on the Canadian post.
“The new guidelines for the administration of pre- and post-exposure prophylaxis for HIV in Canada update the recommendation to offer PEP, following the position previously taken by other agencies in high-income countries, such as the World Health Organization. Center for Disease Control From the United States and British HIV Societyamong other things. Instead, the World Health Organization continues to recommend this strategy only for people who are most at risk.
“The Canadian guidelines expand the offer of preventive prophylaxis to all adolescents and adults who need it, regardless of the outcome of their assessment of risk of infection,” Lusso stressed.
The population effectiveness of PrEP, that is, the strategy’s ability to reduce the number of new cases, depends primarily on a large proportion of those who need it being able to use it.
“Currently, a marginal number of individuals receive preventive care compared to those who need the strategy. This situation is global, not limited to Argentina or other Latin American countries, and is mainly due to the difficulty of implementing relatively complex preventive measures in a healthy, healthy society,” he stressed.
The expert added: “It involves integrating people into the health system who do not necessarily consult, and then following them up periodically, with controls and drug delivery. Without a doubt, The current priority for our countries in the region should be to scale up the implementation of pre-exposure prophylaxis in populations at risk“We still maintain a large deficit.”