AIDS-free generation is aim of new guidelines for clinicians

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AIDS-free generation is aim of new guidelines for clinicians

Best practices involve biomedical advances and behavioral therapy
Bobbi Nodell

Jeanne Marrazzo, a UW professor of medicine, wants people to know that there are tools to prevent HIV but they are not being used like they should.

Marrazzo, was one of the three co-chairs of an interdisciplinary panel of experts that came together to create a simple framework of best practices to optimize the role of
the clinician in achieving an AIDS-free generation. The guidelines, published in the Journal of the American Medical Association, integrate cutting-edge biomedical advances and evidence-based behavioral interventions for people with HIV or at high risk for HIV infection. 


HIV-Marrazzo
picture of Dr. Jeanne Marrazzo
Dr. Jeanne Marrazzo was one of three co-chairs of the guideline-generating panel of experts.
Dr. Jeanne Marrazzo was one of three co-chairs of the guideline-generating panel of experts.

“The tools to prevent HIV infection and disease progression are better than ever, but providers need encouragement and support to integrate best practices in communication and counseling with the biomedical measures that can render patients less- and ideally non-infectious,” said Marrazzo, medical director of the Seattle STD/HIV Prevention Training Center and corresponding author of the paper.

Guidelines are based on a comprehensive review of data published or presented over the past 17 years. Among the recommendations is a call for the use of antiretroviral therapy, which suppresses HIV replication and virtually eliminates the risk of transmitting the virus, for all HIV-infected individuals and as prevention for individuals at high risk of infection.

The guidelines emphasize the value of interventions such as psychosocial counseling and treatment for drug dependence in healthcare systems to help these same individuals to access and remain in high-quality HIV care.

The International Antiviral (formerly AIDS) Society-USA convened the experts from a large group of institutions, including Johns Hopkins University, University of British Columbia, Université de Bordeaux, Evandro Chagas Clinical Research Institute, and Centre for AIDS Research and Education.
 
The panel’s recommendations also include the following:

  • All adults and adolescents should be tested at least once for HIV, with repeated testing for those at increased risk of acquiring it.
  • Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if infection is suspected.
  • Individuals diagnosed with HIV should be linked to care for timely initiation of antiretroviral therapy.
  • Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections should be included in the care of HIV-infected individuals.
  • Uninfected persons at high risk of HIV infection should be prioritized for preventive interventions.
  • Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preventive for persons at high risk for HIV based on recent diagnosis of sexually transmitted infections, use of injection drugs or shared needles, or recent use of post-exposure prophylaxis.
  • For persons who inject drugs, harm-reduction services should be provided: needle and syringe exchange programs, supervised injection, and available medically-assisted therapies such as opioid agonists and antagonists. Low-threshold detoxification and drug cessation programs should be made available.
  • Post-exposure prophylaxis should be initiated as soon as possible for all persons exposed to HIV from a known infected source.

The authors note that while implementing guidelines may present structural, economic or political challenges, the benefits should be substantial in preventing disease progression and preventing new HIV infections.

“These guidelines provide a practical, science-based approach that any clinician can implement,” said David Holtgrave, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and a co-chair of the panel. “They are designed to promote the integration of the best available services—both behavioral and biomedical—and to create a clear pathway to access these services and realize their full benefit.”
 
The International Antiviral Society-USA, a not-for-profit organization, sponsors medical education for medical practitioners who care for people with HIV, HCV, or other viral infections. The organization sponsored and funded the guidelines entirely.

News editors: Please contact Bobbi Nodell (206.543.7129, bnodell@uw.edu) with requests for details or an interview with Dr. Marrazzo.