Posts Tagged 'PrEP'

Preventing HIV: What Every Clinician Needs to Know about Non-Occupational Post-Exposure Prophylaxis

By Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

This is part 3 in a 4 part series of articles detailing New York’s efforts to combat HIV through PrEP and other regiments

If a patient presents to a medical provider with a recent HIV exposure, immediate nPEP (non-occupational post-exposure prophylaxis) administration may prevent HIV transmission. This 28-day regimen is recommended for exposed patients of at least 13 years of age, and the recommended regimen is tenofovir + emtricitabine plus either raltegravir or dolutegravir. Situations that prompt a request for nPEP include condom slippage, breakage or lapse in use, and unsafe needle-sharing.

The NYS Department of Health nPEP guidance states: for maximum effectiveness, nPEP must be administered within 36 hours of exposure, ideally within two hours. If the source person is known to be HIV-infected, the provider should obtain information about his/her viral load and antiretroviral medication history, but do not delay administration of the first dose. After administration, telephone or in-person consultation with an experienced HIV provider is recommended. To speak with a clinician experienced in managing nPEP, call the CEI Line toll-free 24/7 at 1-866-637-2342.

When deciding whether to prescribe nPEP, the clinician should assess the patient’s risk of HIV acquisition based on the type of exposure. The behaviors that confer the highest risk are needle-sharing and receptive anal intercourse with an HIV-infected person. Treatment of these exposures should be combined with a strong educational component that emphasizes prevention of future exposures.

All patients receiving nPEP should be re-evaluated within 3 days of the exposure and weekly during the recommended 28-day regimen to assess adherence and side effects. In addition to the baseline test, HIV testing should also be done at week 4 and week 12 post-exposure regardless of whether nPEP was initiated. If the HIV test result is positive at any time, perform a FDA-approved confirmatory assay to confirm the diagnosis. A negative HIV test result at 12 weeks post-exposure reasonably excludes HIV infection related to this exposure.

A member of the health care team should provide risk-reduction counseling whenever someone is assessed for nPEP, and medical providers should assess for other factors that can contribute to risk behavior. Persons who present with repeated high-risk behavior should be the focus of intensified education and considered for initiation of pre-exposure prophylaxis (PrEP).

Are you up-to-date on nPEP?

The NYS Department of Health Clinical Education Initiative (CEI) provides free CME/CNE trainings on nPEP for medical providers in NYS. To request training or to view online nPEP courses, please visit www.ceitraining.org.

The complete NYS DOH PEP guidelines can be found at http://www.hivguidelines.org.

References

  1. HIV Clinical Resource. NYS Department of Health AIDS Institute, Oct. 2014. Web. 8 June 2015. <http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv-prophylaxis-following-non-occupational-exposure/&gt;
  2. “I might have been exposed to HIV. What should I do?” Web. 8 June 2015. <http://www.hivguidelines.org/wp-content/uploads/2013/12/i-might-have-been-exposed-to-hiv.-what-should-i-do.pdf&gt;.
Advertisements

Pre-Exposure Prophylaxis: A New Strategy in HIV Prevention

by Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

This is part 2 in a 4 part series of articles detailing New York’s efforts to combat HIV through PrEP and other regiments

Although the total number of new HIV infections in NYS is decreasing, rates continue to rise in some populations. For these persons, an effective intervention may be pre-exposure prophylaxis, or PrEP, a once-daily pill consisting of 300 mg tenofovir and 200 mg emtricitabine.

Who should be prescribed PrEP?

HIVPrEP is beneficial for individuals who are HIV-negative, but at ongoing high risk for HIV infection, namely men who have sex with men, injection drug users, and serodiscordant couples where one partner is HIV-positive and the other is HIV-negative. It is important that a negative HIV test result be confirmed immediately before initiation of PrEP. Since PrEP is a prevention tool to use during high-risk periods and not a life-long intervention, the length of use will depend on the individual’s risk behaviors.

Pre-education

Before prescribing PrEP, providers must explain to the patient how the medication works and the need for strict adherence. Patients must also understand that PrEP is not a sole intervention, but part of a comprehensive prevention plan that includes counseling about the following: consistent condom use, safer-sex practices, the importance of frequent HIV testing and, for individuals in serodiscordant relationships, the importance of suppressive ART (anti-retroviral treatment) for the HIV-infected partner.

Follow-Up and Monitoring

The first prescription of PrEP should be for 30 days. A follow-up visit should be scheduled at 2 weeks and 30 days to assess adherence and tolerance. At the 30-day visit, a prescription for 60 days may be given and, after that visit, prescriptions for 90 days may be given as long as the patient is adherent. Follow-ups should occur at least every 90 days. At each follow-up, the medical provider must give an HIV test, provide risk-reduction counseling, and manage side-effects.

Discontinue PrEP immediately if the patient receives a positive HIV test result, develops renal disease, is non-adherent or using the medication for unintended purposes, or has reduced risk behaviors to the extent that PrEP is no longer needed.

Are you up-to-date on PrEP?

The New York State (NYS) Department of Health Clinical Education Initiative (CEI) provides free trainings on PrEP for medical providers in NYS. To request a training or to view on-line PrEP courses, please visit www.ceitraining.org. To speak with a clinician experienced in managing PrEP, call the CEI line toll-free at 1-866-637-2342.

The complete NYS DOH PrEP guidelines can be found at http://www.hivguidelines.org.

References

  1. HIV Clinical Resource. NYS Department of Health AIDS Institute, Jan. 2014. Web. 15 June 2015. <http://www.hivguidelines.org/clinical-guidelines/pre-exposure-prophylaxis/guidance-for-the-use-of-pre-exposure-prophylaxis-prep-to-prevent-hiv-transmission/&gt;

The New York State Plan to End AIDS: What Every Medical Provider Needs to Know

by Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

New York State (NYS) has made tremendous strides in decreasing HIV infection rates over the past decade. In order for the AIDS epidemic to be brought to sub-epidemic levels and the first ever decrease in HIV prevalence, NYS must aim to decrease new HIV infections from 3,300 to 750 annually, and reduce the rate at which persons diagnosed with HIV progress to AIDS by 50%. In June of 2014, Governor Andrew M. Cuomo announced a three-point plan to end the AIDS epidemic in NYS by the end of 2020. The plan’s stated goals involve:

  • Identifying persons with HIV who remain undiagnosed and linking them to health care. There are approximately 22,000 people living with HIV in NYS who are unaware of their status. It is critical that access to voluntary HIV testing be increased so individuals can access treatment if they test HIV-positive. Since 2010, NYS Public Health Law has required that medical providers offer HIV testing to all patients ages 13 to 64 as a routine part of health care.
  • Linking and retaining persons diagnosed with HIV to health care and getting them on anti-HIV therapy to maximize HIV virus suppression so they remain healthy and prevent further transmission. In NYS, approximately 64,000 of the 132,000 persons living with HIV are receiving sub-optimal treatment. It is imperative that medical providers identify and link patients to care as soon as possible.
  • Providing access to pre-exposure prophylaxis (PrEP) for high-risk persons to keep them HIV-negative. PrEP is a biomedical intervention for high-risk individuals who are currently HIV-negative. It involves the person taking Truvada, a once-daily pill consisting of tenofovir and emtricitabine. In order to expand on the utilization of PrEP as a prevention tool, the Governor’s plan recommends focusing on education and awareness, affordability, and enhanced availability.


Are you up-to-date on the Governor’s Plan to End AIDS?

The NYS Department of Health Clinical Education Initiative (CEI) provides free CME/CNE trainings for medical providers in NYS. To request a training or to view on-line HIV courses, please visit www.ceitraining.org. To speak with a clinician experienced in managing HIV or PrEP, call the CEI Line toll-free at 1-866-637-2342.

References

  1. “2015 Blueprint to End AIDS.” NYS Department of Health, 30 Mar. 2015.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 988 other followers

Follow NYACP on Twitter

Archives

Advertisements