![]() Transmission via intravenous drug use was reduced by 74% in those with detectable tenofovir levels. 2 Lower adherence reduces PrEP effectiveness – if four pills are taken per week, effectiveness is reduced to 96% and falls rapidly after that as adherence drops. PrEP taken daily reduces HIV infection via sexual transmission by 99%. Source: ASHM PrEP Guidelines September 2019 update Pregnancy test (for women of child-bearing age)ĮGFR estimated glomerular filtration rate syphilis, gonorrhoea, chlamydia) as per Australian STI Management GuidelinesĪt least every 6 months or according to risk of chronic kidney disease non-sterile injection drug use and MSM with sexual practices that pre-dispose to anal trauma ![]() If patient required hepatitis B vaccine at baseline, confirm immune response 1 month after last vaccine doseġ2 monthly, but more frequently if ongoing risk e.g. Hepatitis B serology (vaccinate if non-immune) ![]() HIV testing and assessment for signs or symptoms of acute infection Table - Laboratory evaluation and clinical follow-up of individuals who are prescribed pre-exposure prophylaxisġ month after starting PrEP (optional but recommended in some jurisdictions) Additional drugs are needed for HIV treatment regimens. PrEP is not recommended in people who already have HIV because dual therapy with tenofovir disoproxil/ emtricitabine is insufficient to suppress HIV and there is a risk of drug resistance developing. These groups have not shown declines in new HIV infections. ![]() While PrEP has been particularly effective in reducing new HIV infections in Australian-born men who have sex with men, there is a need to ensure the provision of PrEP to overseas-born men who have sex with men, heterosexuals at risk, and Aboriginals. Sex workers and people who use intravenous drugs are also at risk of HIV, as are some transgender people and heterosexuals who engage in high-risk behaviour. use of illicit drugs, particularly crystal methamphetamine because of its effect on behaviour.a history of sexually transmitted infections, particularly anorectal gonorrhoea and chlamydia.A high risk of HIV infection has been associated with: Men who have sex with men account for approximately 70% of HIV diagnoses in Australia. PrEP is indicated for people who are at risk of HIV infection, or have fears related to acquiring it. There has been a reduction of up to 50% in men who have sex with men living in inner cities. Only since the widespread uptake of PrEP in 2016 1 has there been a dramatic fall in new infections ( see editorial in this issue). This resulted in a plateauing but not a reduction of new diagnoses. Initial approaches included increased testing to identify undiagnosed cases, and encouraging treatment of every person with HIV to reduce viral load and transmission in the community (known as treatment as prevention or TasP). Since 2012, state health authorities have attempted to tackle the rising incidence more systematically. Since 2000, there was a gradual increase in new HIV diagnoses in Australia, particularly in men who have sex with men. With variable use of condoms and in the absence of an HIV vaccine, other measures have been necessary to reduce HIV transmission. There are also the lifelong costs of treatment. Nevertheless, there is a burden of comorbidities associated with HIV infection due to increased inflammation even with virus suppression. HIV is no longer a terminal diagnosis, but can be well managed as a chronic condition with almost normal life expectancy. In addition to preventing new HIV infection in individuals, and the fears associated with this, pre-exposure prophylaxis (PrEP) has been a major public health development for the community.
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