TRANSMISSION
Non-occupational Post-exposure Prophylaxis and Antiretroviral Pharmacokinetics in the Male and Female Genital Tracts
In January of 2005, the United States Centers for Disease Control and Prevention released its revised guidelines for nonoccupational postexposure prophylaxis (PEP) of HIV transmission for high-risk sexual contacts. These guidelines have raised many questions about the evidence supporting PEP and the ways in which it is best provided to patients in clinical settings. The idea of using antiretrovirals to prevent transmission is not new, since guidelines for occupational exposures have existed since 1996. For sexual transmission, prophylaxis with antiretrovirals before a potential exposure—pre-exposure prophylaxis (PrEP)—or after the exposure occurs (PEP) is controversial and often leaves clinicians unsure of how to provide the best care to their at-risk patients.
Integrating Rapid HIV Testing Into Fast-Paced Private Practice Settings
When it comes to HIV infection, the need for improved diagnostic care couldn’t be more evident. According to the U.S. Centers for Disease Control (CDC), 29% of HIV-infected persons in this country are unaware of their HIV status. CDC surveillance data also indicate that 37% of persons who test positive for HIV develop AIDS within a year after their diagnosis, meaning that many individuals likely remain unaware of their infection for several years, potentially putting their own health—and the health of others—in jeopardy. New York City Department of Health and Mental Hygiene (NYC DOHMH) statistics mirror those of the CDC: approximately 25% of HIV-positive New Yorkers learn that they are infected with HIV at the time of an AIDS diagnosis.
Can the HIV/AIDS Epidemic in New York City be Stopped?
As of December 31, 2003, a total of 88,479 New Yorkers have been diagnosed, reported, and are known to be living with HIV or AIDS. Dr. Frieden explained that 57,316 (64.7%) have already received an AIDS diagnosis and that 31,163 (35.3%) are infected with HIV but have not met the immunologic or clinical case definition for AIDS. “Of central concern to us,” Dr. Frieden said, “is that we probably have another 20,000 New York City residents who are HIV-positive but aren’t aware of their status.”
The President’s Emergency Plan for AIDS Relief
There are between 38 and 42 million people worldwide infected with HIV, 95% of whom live in developing countries (see Figure 1). HIV/AIDS has killed more than 20 million people worldwide, with approximately 3.1 million deaths reported in 2002 alone. AIDS is the leading cause of death in Africa, where approximately 70% of the worldwide epidemic is concentrated, and the fourth-leading cause of death worldwide.
Feasible Primary HIV Infection Screening: The North Carolina Experience
Where is no shortage of data suggesting that people with primary HIV infection (PHI) are, unknowingly, significant contributors to the spread of HIV. In turn, public health initiatives surrounding PHI—whether its aggressive testing and counseling of acutely infected individuals, stepped-up contact tracing efforts, or the use of HAART—need to be considered carefully in the larger context of HIV/AIDS prevention efforts
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Transmission of Drug-Resistant HIV Transmission of Drug-Resistant HIV
The HIV medical community received an official wakeup call on July 30, 1998, when Dr. Frederick M. Hecht —a frequent PRN lecturer—and his colleagues published the first documented case of high-level protease inhibitor resistance in a recently infected, treatment-naïve, HIV-positive individual. Since this initial report, a number of researchers with close ties to primary HIV infection cohorts have not only confirmed that transmission of drug-resistant HIV is possible, but that it is occurring in up to 20% of all new HIV infections identified in North America in recent years (Little, 2002).
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Advancing HIV Prevention: New CDC Strategies for a Changing Epidemic A Report from the U.S. Centers for Disease Control
In several U.S. cities, recent outbreaks of primary and secondary syphilis among men who have sex with men (MSM) (CDC, 2002), along with increases in newly diagnosed HIV infections among MSM and heterosexuals, have created concern that HIV incidence might be increasing. In addition, declines in HIV morbidity and mortality during the late 1990s attributable to HAART appear to have ended.
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