By Moses Alfaro, BSA and Colton Blinka, BSA

Prevention and Management of HIV in the 21st Century

By Moses Alfaro, BSA and Colton Blinka, BSA

Once thought to be an untreatable disease, HIV is now largely preventable and manageable with new therapeutics that have been developed since the AIDs epidemic in the 1980s. While society has made great strides in developing treatments that allow people living with HIV to lead normal lives, there are still clusters of individuals who go untreated and mistakenly transmit this disease. Our article explores the numerous ways to prevent transmission of HIV and what options are available for treatment if one is to contract this disease.

Transmission and prevention

The way HIV is transmitted plays a crucial role in how to prevent contracting it. HIV is transmitted through bodily fluids like blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids and breast milk.1 In the United States, the most common activities that lead to transmission are having sex with someone who has HIV, sharing injection equipment (e.g., needles), or from mother to child during pregnancy or birth through breastfeeding.1

Not sharing needles, using condoms during anal or vaginal sex, or practicing abstinence by not having sex help in the prevention of HIV.2 Some individuals might not be aware that these activities can post a high risk of contracting HIV, so its paramount to spread this awareness. In addition to these prevention tips, there are some medications available to aid in prevention like PrEP (pre-exposure prophylaxis) or PEP (post-exposure prophylaxis). PrEP is a prescribed medication that is taken as a pill and can reduce the risk of contracting HIV by 99% when taken as prescribed.3 It’s generally recommended to keep using a condom with PrEP to prevent other sexually transmitted diseases (STDs), as PrEP only works against HIV.3 As for PEP, this is used whenever you have been possibly exposed to HIV and should be used within 72 hours of the expsoure.4

Diagnosis and symptoms

Early diagnosis of HIV is paramount because it can aid in receiving treatment that can prevent any complications or unwanted symptoms, and it can help in reducing the spread of the disease to any other individuals. A common way that HIV can be diagnosed is through the ELISA (enzyme-linked immunosorbent assay) test, which can detect antibodies to the virus through a blood draw.5 However, antibodies to the HIV infection aren’t produced immediately when you are infected, so there can be a window of a couple of weeks where ELISA cannot detect an infection due to the lack of antibodies produced, causing a false negative.5 If the ELISA is positive for antibodies, a western blot test will be ordered to confirm the results because it is very sensitive to

the antibodies produced against HIV.5 Another test, called a nucleic acid test (NAT), can look for the actual virus in the blood.6 Although this test can detect HIV sooner than other tests, it is a very expensive test and can only be used after a patient has had a high risk exposure or are presenting with symptoms of the disease.6

Symptoms of HIV can usually be mistaken for another viral disease, so this further emphasizes the importance of getting tested to ensure you do not have an infection. Usually, early HIV symptoms can occur within a couple weeks or months from the time of infection.7 Symptoms can include fever, headache, fatigue, swollen lymph nodes, rash, sore throat, or sore muscles and joints.7 These symptoms are nonspecific so it can be challenging for people to recognize that it can be due to an HIV infection. If you are at risk for contracting HIV, it is recommended to get tested and be aware of any viral symptoms that might arise.

Treatment

When it comes to HIV, treatment is prevention. By reducing the viral load of an individual with HIV, the risk of future transmission drops precipitously. Current standard of care calls for the treatment of a newly diagnosed HIV patient with highly active antiretroviral therapy (HAART) regardless of that patient’s CD4 count or symptoms.8 HAART is a regimen of three to four drugs, each of which target a different stage of the viral life cycle to ensure that resistance to any one drug won’t cause the treatment to be unsuccessful. With proper patient adherence, HAART has been shown to reduce morbidity, mortality and transmission of HIV.9

Adherence, though, can be a significant challenge to people being treated with HAART. Whenever possible, a HAART regimen should be chosen that consists of a single co-formulated tablet taken orally once a day. However, certain patients may have contraindications to the currently available co-formulated tablets and have to take as many as three to four pills twice a day, instead.10 In situations such as these, it is paramount for the interprofessional care team to stress the importance of adherence, and provide strategies to improve adherence. These strategies include patient education, seven-day pillboxes, and downloadable phone applications and alarms.

Conclusion

HIV is not once what it was in the late 1900s. With a plethora of options to treat the disease, and with new drugs in the works, people living with HIV can lead relatively normal lives. It's important for healthcare leaders in the community to educate and spread awareness of how to protect yourself from contracting HIV, how to test for it and what options are available for treatment. References 1. Content Source: HIV.govDate last updated: June 24, 2019. (2021,

January 26). How is HIV transmitted? HIV.gov. Retrieved April 8, 2022, from https://www.hiv.gov/hiv-basics/overview/abouthiv-and-aids/how-is-hiv-transmitted 2. Centers for Disease Control and Prevention. (2021, May 25). Pep.

Centers for Disease Control and Prevention. Retrieved April 8, 2022, from https://www.cdc.gov/hiv/basics/pep.html 3. Centers for Disease Control and Prevention. (2021, May 13). Prep effectiveness. Centers for Disease Control and Prevention. Retrieved April 8, 2022, from https://www.cdc.gov/hiv/basics/prep /prep-effectiveness.html 4. Centers for Disease Control and Prevention. (2021, May 25). Pep.

Centers for Disease Control and Prevention. Retrieved April 9, 2022, from https://www.cdc.gov/hiv/basics/pep.html 5. HIV diagnosis. ucsfhealth.org. (n.d.). Retrieved April 9, 2022, from https://www.ucsfhealth.org/conditions/hiv/diagnosis# :~:text=ELISA%20Test%20ELISA%2C%20which%20stands,in %20one%20to%20three%20months. 6. Centers for Disease Control and Prevention. (2022, April 19).

Types of HIV tests. Centers for Disease Control and Prevention.

Retrieved April 9, 2022, from https://www.cdc.gov/hiv/basics/ hiv-testing/test-types.html 7. Mayo Foundation for Medical Education and Research. (2020,

November 21). Early HIV symptoms: What are they? Mayo

Clinic. Retrieved April 9, 2022, from https://www.mayoclinic.org/ diseases-conditions/hiv-aids/expert-answers/early-hivsymptoms/faq-20058415 8. Eggleton JS, Nagalli S. Highly Active Antiretroviral Therapy (HAART) [Updated 2021 Nov 25]. In: StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554533/ 9. Kemnic TR, Gulick PG. HIV Antiretroviral Therapy. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): Stat-

Pearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513308/ 10. Justiz Vaillant AA, Gulick PG. HIV Disease Current Practice. [Updated 2021 Dec 15]. In: StatPearls [Internet]. Treasure Island (FL):

StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534860/

Moses Alfaro, BSA and Colton Blinka, BSA are medical students at UT Health San Antonio Long School of Medicine. Moses is a member of the BCMS Publications Committee.