ABSTRACT
Human immunodeficiency virus (HIV) prevention and treatment updates include screening recommendations, fourthgeneration testing, preexposure prophylaxis, and a paradigm shift; treatment is prevention. The U.S. Preventive Services Task Force recommends routine HIV screening in persons 15 to 65 years of age, regardless of risk. Fourth-generation testing is replacing the Western blot and can identify those with acute HIV infection. The U.S. Food and Drug Administration approved the OraQuick In-Home HIV Test; however, there are concerns about reduced sensitivity, possible misinterpretation of results, potential for less effective counseling, and possible cost barriers. Preexposure prophylaxis (effective in select high-risk adult populations) is the combination of safer sex practices and continuous primary care prevention services, plus combination antiretroviral therapy. Concerns for preexposure prophylaxis include the necessity of strict medication adherence, limited use among high-risk populations, and community misconceptions of appropriate use. Evidence supports combination antiretroviral therapy as prevention for acute HIV infection, thus lowering community viral loads. Evidence has increased supporting combination antiretroviral therapy for treatment at any CD4 cell count. Resistance testing should guide therapy in all patients on entry into care. Within two weeks of diagnosis of most opportunistic infections, combination antiretroviral therapy should be started; patients with tuberculosis and cryptococcal meningitis require special considerations.
ABSTRACT
Human Immunodeficiency Virus (HIV) epidemic continues to represent a major global health issue. Today, there are several tools available to prevent the spread of HIV infection. However, there are several constraints to the current prevention strategies including low condom use, low acceptance of testing, low awareness of vulnerability and more emphasis on treatment. Prevention strategy is redirected towards reducing acquisition of HIV. Pre-exposure prophylaxis or PrEP is the latest groundbreaking innovation in biomedical research in the prevention of HIV transmission. The purpose of this paper is to review preexposure prophylaxis for HIV prevention including the current guidelines in the use of PreP.
El virus de la Inmunodeficiencia Humana (VIH) continúa representando un importante problema de salud mundial. Hoy en día, existen varias herramientas disponibles para evitar la propagación de la infección por el VIH. Sin embargo, existen varias restricciones a las estrategias de prevención actuales, incluyendo el bajo uso del condón, baja aceptación de la prueba, la escasa conciencia de la vulnerabilidad y un mayor énfasis en el tratamiento. La estrategia de prevención se redirige hacia la reducción de la transmisión del VIH. La profilaxis pre-exposición o "PrEP" es la última innovación pionera en la investigación biomédica en la prevención de la transmisión del VIH. El propósito de este trabajo fue revisar la profilaxis de pre-exposición para la prevención del VIH, incluyendo las directrices actuales en el uso de PrEP.
Subject(s)
Humans , HIV , Disease Prevention , AIDS SerodiagnosisABSTRACT
PURPOSE: This study aims to investigate preexposure prophylaxis and postexposure prophylaxis of rabies that the National Medical Center (NMC) handled and to check whether appropriate measures were performed according to the recent domestic and overseas guidelines after animal bites. METHODS: This study surveyed 41 people who were 18 years or under and received preexposure and postexposure prophylaxis of rabies at the NMC from November 2006 to December 2011. Their medical records were reviewed for their age, gender, the reason for preexposure prophylaxis, the body sites of animal bite, the kind of the animal that bit children, the region where the biting occurred and rabies vaccination and inoculation of immunoglobulin. RESULTS: Eleven children took rabies vaccination for preexposure prophylaxis and 30 children received post exposure prophylaxis of rabies. Of patients who were bitten by unvaccinated animals including wild animals or by animals which were not certain to be vaccinated, 50% (13 of 26 children) received postexposure prophylaxis, while 75% (3 of 4 children) of patients who were bitten by vaccinated animals received postexposure prophylaxis of rabies. Ten of 30 bitten patients knew whether or not the biting animals had received rabies vaccination. Of them, four people (40%) were bitten by animals which had received rabies vaccination. CONCLUSION: To prevent the occurrence of rabies, people and health care providers need to correctly understand latest guideline for rabies preexposure and postexposure prophylaxis and the information for bitten patient, biting animal and area at bitten by animal should be accurately recorded.