HIV prevention

Mizz dr rajesh gandhi i’m an infectious disease physician at massachusetts general hospital in boston and we recently published an r single pill combination regimens for hiv infection in the new england journal of medicine so unfortunately needle sticks are still common they can occur in the operating room that can occur when a healthcare worker is drawing blood

There are a couple of risk factors that relate to whether we put people on what we call post-exposure prophylaxis that is we put people on a medicine to try to prevent hiv if it’s a very deep needle stick that’s one risk factor for transmitting hiv if it’s the needle is in a patient’s artery or vein as opposed to in their skin that’s another risk factor and then

Of course if the patient has a high at level of hiv that’s a third risk factor so if any of those three are there a very deep needle stick the blood the needle was in an artery or vein or if the patient has hiv with a high viral load we do try to immediately start medicines to prevent hiv the one that we use most commonly these days is a combination of truvada and

Raltegravir and the current guideline is to give it for 28 days that is 28 days from the time you the exposure happens and then we follow patients up after those 28 days for a total of about six months the one that’s commonly used is not a single pill it’s a truvada plus regular so it’s actually two pills i’m sorry a total of three pills a day truvada is one pill a

Day and brought a gear is one pill in the morning and one pill at night so that particular popular combination is three pills a day one of the medicines we reviewed in our new england journal of medicine article is called stribild that is one pill once a day and that is now being tested for use in people who have needle sticks sews tribal there’s another option it’s

Been less well studied and is currently undergoing testing what you’re referring to is what’s called pre exposure prophylaxis what i was in the needle sticks situation we call it pep or post-exposure prophylaxis that is giving a pill after someone has an exposure there’s also a new concept just a few years old called pre exposure prophylaxis there’s been a number of

Tests of a drug called truvada which is hiv medicine it’s a two in one pill and a number of studies in men who have sex with men in high-risk heterosexual groups and in injection drug users that truvada can prevent acquisition of hiv and so the cdc the center for disease control just last month made a recommendation that people in certain high-risk groups people have

In high-risk sex injection drug users be offered truvada to try to prevent hiv acquisition shin so let me answer in two ways the world health organization also just like last month made the same recommendation of the cdc did which is that pre exposure prophylaxis be given to high-risk patients i will say on the ground in reality right now the focus is to try to

Get people who are already hiv-infected on therapy we’ve made a lot of strides but there’s still a ways to go before all hiv infected people are on therapy but in very high-risk settings in other countries i do think it will play a role i think it’s not yet being rolled out to a massive scale the wh 0 just made that recommendation within the last few weeks you know

In the world of pre exposure prophylaxis i think there still needs to be more funding there’s not a single donor or single set of donors that have really pushed that the whole donor community has been integral to getting people on a chat with hiv on therapy so the global fund for treatment of hiv tuberculosis and malaria has been funded by by big donors including

The gates foundation george w bush in the hiv world gets a lot of credit for funding what’s called pepfar bush created a program called the president’s emergency plan for aids relief what he did is he funded two massive scale an unprecedented scale treatment of hiv and poor countries around the world to the tune of several billion dollars a year and so george

Bush in the hiv world has really gets enormous amounts of credit i think that’s one of his signature achievements is to roll out pepfar tap fire continues under obama with the global recession the rate of increase in pepfar funding has slowed but it is still very prominent and is a big player in the world of treating people with hiv around around resource-limited settings in particular

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HIV prevention By The Healthcare Channel