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prevalence groups ) or has a partner who is HIV positive and not on treatment , they may benefit from being offered PrEP treatment .
Think PEP
6PEP ( Post Exposure Prophylaxis ) is 28 days of HIV prevention treatment that can be taken after having unprotected higher-risk sex with someone who may be HIV positive . It needs to be started within 72 hours of the sex ( the earlier the better ). PEP can be accessed from sexual health clinics , and also from A & E departments out of hours . It can have some unpleasant side-effects , such as nausea and diarrhoea , but is highly effective at preventing HIV seroconversion . 8
‘ Undetectable equals Untransmittable ’ ( U = U )
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The global health community has coined the slogan ‘ U = U ’. This helps promote the fact that , if someone is HIV positive , has been on antiretroviral treatment for six months and has an undetectable viral load , there is no risk of their passing it on to anyone they have sex with regardless of the sexual activity or whether a condom is used . 9 The earlier we diagnose people with HIV , the sooner we can start treatment and prevent transmission to others .
References 1 Coffin J et al . What to call the AIDS virus ? Nature 1986 ; 321:10 2 Terrence Higgins Trust . UK Government to commit to ending new HIV transmissions in England by 2030 . January 2019 . bit . ly / 3pfSFPh 3 Presanis A et al . Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030 : an evidence synthesis model . Lancet Public Health 2021 ; 6 : e739-e751 . bit . ly / 35raCn7 4 May MT . Better to know : the importance of early HIV diagnosis . Lancet Public Health 2017 ; 2 : e6-e7 . bit . ly / 3HeS5aH 5 British HIV Association . UK guideline for the use of HIV post-exposure prophylaxis . 2021 . bit . ly / 3JQEo3n 6 British HIV Association . BHIVA / BASHH guidelines on the use of HIV pre-exposure prophylaxis ( PrEP ) 2018 . bit . ly / 3si2bUc 7 Medical Research Council . The Proud Trial . proud . mrc . ac . uk 8 Siedner M et al . HIV post-exposure prophylaxis ( PEP ). BMJ 2018 ; 363 : k4928 9 National AIDS Map . NAM endorses Undetectable equals Untransmittable ( U = U ) consensus statement . February 2017 . bit . ly / 3t2lkbL 10 EUROtest . HIV Indicator Conditions : Guidance for implementing HIV testing in adults in health care settings . bit . ly / 36CO833
The rate and risk of HIV transmission is dependent on both the activity of concern and the HIV prevalence among the parties involved . Detailed advice for calculating risks can be found in British HIV association ( BHIVA ) guideline on post-exposure prophylaxis . 5 Understanding and being realistic about risks can be helpful when discussing harm-reduction strategies with our patients .
Act early
4Early diagnosis and treatment are key factors influencing the likelihood of a good outcome for someone living with HIV . 4 Once the person is on treatment , the virus will be suppressed . This means it cannot replicate or destroy CD4 cells – the white blood cells that fight infection – meaning the immune system does not become compromised . It also means that the person has no freely circulating virus , so HIV cannot be passed to partners . Anyone starting a new relationship or who regularly has new sexual partners should be encouraged to test for all STIs .
Be PrEPared
5Although condoms are very effective and protect against other STIs as well as HIV , not everyone remembers or has the agency to use them every time they engage in sexual contact . There is now a treatment known as PrEP ( Pre-Exposure Prophylaxis ) which can be taken daily , or as event-based treatment taken before and after sex . PrEP is highly effective at preventing HIV transmission . 6 , 7 It is available free from most NHS sexual health services . If your patient discloses that they are engaging in higher-risk activities ( such as unprotected anal sex with people from high
Ask for advice
8If you think a patient would benefit from some more discussion around HIV , whether they are reluctant to test , need to explore risk reduction or want more information about HIV , most sexual health clinics have a health adviser service that can take referrals from other agencies . Charities like Terrence Higgins Trust , NAM and I Want PrEP Now are also useful places to signpost patients , or to access evidence-based information ( see Useful websites , below ).
Look out for symptoms
9In the early stages of HIV infection , patients can experience ‘ classic ’ viral symptoms . A typical presentation of HIV seroconversion would be fever , rash and sore throat . As HIV progresses and begins to attack immune cells , symptoms can vary widely and patients may present in general practice , or to a specialist service . Some indicator conditions may be very common , such as pneumonia or generalised lymphadenopathy . 10 In any condition not responding to the usual treatment , it is worth considering HIV as a differential diagnosis .
Make it routine a patient attends for routine blood tests , to discuss contraception or for cervical 10When
screening , these are ideal opportunities to offer routine HIV testing . Separate counselling is not required , and the conversation can be as simple as : ‘ While I am doing your blood test , is it ok if I add an HIV test in too ? It won ’ t require any extra needles .’ The majority of patients are happy to be tested for HIV when having other blood tests done , and many assume it is done routinely anyway . Some A & E departments are trialling routine HIV testing of all patients . Increasing testing opportunities will help to reduce stigma , identify undiagnosed individuals and hopefully help us reach the target of no new HIV diagnoses by the year 2030 .
Useful websites
Terrence Higgins Trust tht . org . uk /
NAM aidsmap . com /
I want PrEP now iwantprepnow . co . uk /
Prepster prepster . info /