Join the emDOCs.net podcast with Jess Pelletier, MD, discussing the urgency of HIV prevention, risk factors for transmission, and the importance of post-exposure prophylaxis. Dive into the use of Truvada in PEP regimens, medications considerations, and strategies to enhance provider comfort with prescribing PEP.
Global incidence of HIV is decreasing, but rising in the U.S., emphasizing the need for prevention programs.
Various factors influence HIV transmission risk, including sexual activities and occupational exposure conditions.
Deep dives
Global Statistics on HIV Incidence and Mortality
Globally, 0.5% of people are infected with HIV with 5,000 new daily infections. In the U.S., there was an increase in new cases from 15.6 to 21 per 100,000 people between 2016 and 2019. Availability of antiretroviral therapy, prevention programs, and prophylaxis has led to a decrease in global incidence but a rise in the U.S. The high morbidity and substantial healthcare costs highlight the importance of preventing new infections.
Risk of HIV Transmission through Different Exposure Routes
Various sexual activities pose different risks of HIV transmission per act, with receptive anal intercourse having the highest risk. Factors like genital piercings, coexisting syphilis, and mucosa thickness influence transmission rates. Injection drug use carries a seroconversion rate of 0.7 to 0.8%. Factors affecting occupational seroconversion risk include needle characteristics, blood contamination, and source patient conditions like high viral load.
Post-Exposure Prophylaxis (PEP) Efficacy and Indications
PEP can reduce seroconversion risk significantly when administered within 72 hours of exposure. Studies show a 89% reduction in seroconversion with prompt PEP initiation. Indications for PEP include percutaneous injuries, mucous membrane exposures, and specific potentially infectious fluids for both occupational and non-occupational exposures. Guidelines emphasize the importance of timely PEP administration to mitigate HIV transmission.