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Prevention of HIV/AIDS

Article information

J Korean Med Assoc. 2007;50(4):330-336
Publication date (electronic) : 2007 April 30
doi : https://doi.org/10.5124/jkma.2007.50.4.330
Moon Won Kang, MD
Department of Internal Medicine, The Catholic University College of Medicine, Korea. infect@catholic.ac.kr

Abstract

The prevention of HIV infection is based on strategies that interrupt sexual, blood-borne, and perinatal transmission of the virus. Post-exposure prophylaxis using anti-retroviral therapy is recommended in case of mucosa or injured skin when exposed to blood, semen, vaginal/anal secretion, breast milk, or body fluid containing visible blood within no more than 72 hours. The combination of antiretroviral prophylaxis, elective caesarean delivery, and avoidance of breast feeding has reduced perinatal transmission to less than 2%. Because prophylactic chemotherapy does not guarantee perfect prevention and the adverse effects or toxicity of the drugs are considerably high, a subject who is willing to continue on with the highly risky behavior would not be a proper candidate for post-exposure prophylaxis. There is no evidence that a three-drug regimen is more likely to be effective than a two-drug regimen; however, the recommendation of a three-drug regimen is based on the assumption that the maximal suppression of viral replication will provide the best chance of preventing infection. The most frequently administered regimen is zidovudine (600 mg per day in two or three divided doses) and lamivudine (150 mg orally twice a day) for 4 weeks, with or without the addition of a protease inhibitor in selected cases.

Keywords: HIV/AIDS; Postexposure prophylaxis; Healthcare workers; Perinatal infection

References

1. Kourtis AK, Lee FK, Abrams EJ, Jamieson DJ, Bulterys M. Mother-to-child transmission of HIV-1: timing and implications for prevention. Lancet Infect Dis 2006. 6726–732.
2. Connor EM, Sperling RS, Gelber R. Reduction of maternalinfant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994. 3311173–1180.
3. Guay L, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomized trial. Lancet 1999. 354795–802.
4. Mandelbrot L. Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA 2001. 2852083–2093.
5. The European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomized clinical trial. Lancet 1999. 3531035–1039.
6. Mofenson LM. the Committee on Pediatric AIDS. Technical report: perinatal human immunodeficiency virus testing and prevention of transmission. Pediatrics 2000. 106e88.
7. Wade NA, Birkhead GS, French PT. Short courses of zidovudine and perinatal transmission of HIV. N Engl J Med 1999. 3401040–1043.
8. Henderson DK, Fahey BJ, Willy M, Schmitt JM, Carey K, Koziol DE, Lane HC, Fedio J, Saah AJ. Risk of occupational exposure of human immunodeficiency virus type 1(HIV-1) associated with clinical exposures: A prospective evaluation. Ann Intern Med 1990. 113740–746.
9. Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL. Occupationally acquired human immunodeficiency virus (HIV) infection : national case surveillance data during 20 years of the HIV epidemics in the United States. Infect Control Hosp Epidemiol 2003. 2486–96.
10. Choi SM, Lee JY, Oh HS, Park ES, Kim SW, Kim YR, Shin DH, Chung MH, Cho GJ, Song JH, Woo JH, Kim JM, Choe KW, Park SC, Kang MW. Survey of HIV exposure and postexposure prophylaxis among health care workers in Korea. Korean J Nosocomial Infect Control 2002. 765–73.
11. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, Heptonstall J, Ippolito G, Lot F, McKibben PS, Bell DM. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997. 3371485–1490.
12. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996. 1753–85.
13. Panlilio AL, Cardo DM, Grohskopf LA, Heneine W, Ross CS. Updated U.S. Public Health Service guidelines for the management of occupational exposure to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005. 541–17.
14. Overview of HIV prevention http://www.avert.org/hivprevention.htm.
15. CDC. Update: Transmission of HIV infection during an invasive dental procedure-Florida. MMWR 1991. 4021–33.
16. Lowenfels AB, Wormser G. Risk of transmission of HIV from surgeon to patient. N Engl J Med 1991. 325888–889.
17. Pinkerton SD, Martin JN, Roland ME, Katz MH, Coates TJ, Kahn JO. Cost-effectiveness of postexposure prophylaxis after sexual or injection-drug exposure to human immunodeficiency virus. Arch Intern Med 2004. 16446–54.
18. Del Rio C, Curran JW. In : Mandell GL, Bennet JE, Dolin R, eds. Epidemiology and prevention of acquired immunodeficiency syndrome and human immunodeficiency virus infection. Principle and practice of infectious diseases 2005. 6th edth ed. Philadelphia: Elsevier; 1477–1506.
19. Schwebke JR. Abnormal vaginal flora as a biological risk factor for acquisition of HIV infection and sexually transmitted diseases. J Infect Dis 2005. 1921315–1317.
20. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: ANRS 1265 Trial. PLoS Med 2005. 2e298.
21. Stein ZA. Vaginal microbicides and prevention of HIV infection. Lancet 1994. 343362–363.
22. Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Service. MMWR Recomm Rep 2005. 541–20.
23. Katzenstein TL, Dickmeiss E, Aladdin H, Hede A, Nielsen C, Nielsen H, Jorgensen LB, Gerstoft J. Failure to develop HIV infection after receipt of HIV-contaminated blood and postexposure prophylaxis. Ann Intern Med 2000. 13331–34.
24. Bloch M, Carr A, Vasak E, Cunningham P, Smith D. The use of HIV post-exposure prophylaxis after successful artificial insemination. Am J Obst Gyencol 1999. 181760–761.

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Copyright © 2007 Korean Medical Association

Table 1

Summary of universal precautions

Table 1

Table 2

Recommended HIV postexposure prophylaxis for percutaneous injuries in healthcare worker

Table 2

*Less severe: solid needle, superficial injury

†More severe: large bore hollow needle, deep puncture, visible blood on device, or needle used in patient's artery or vein

‡HIV+Class 1: asymptomatic HIV infection or known low viral load(eg, < 1,500 copies/ml )

§HIV+Class 2: symptomatic HIV infection, AIDS, acute seroconversion, or known high viral load

∥Basic regimen: AZT or stavudine or tenofovir + lamivudine or emtricitabine

Expanded regimen: Basic regimen + Protease inhibitor