HIV Post-Exposure Prophylaxis (PEP)

Adherence to ART

• Adherence to ART should be regularly assessed by self-report at every clinic visit.
• People with HIV having difficulties with adherence to appointments or ART should be provided additional adherence support using a constructive, collaborative, non-judgmental, and problem-solving approach.

Treatment Goals

• Only 70% to 75% of all people living with HIV in SA are currently on treatment.
• UNAIDS 95:95:95 goals: 95% of all people with HIV know their status, 95% of those who know their status are on treatment, and 95% of those on treatment are virally suppressed.
• SA's progress towards the UNAIDS goals: 94% (status), 79% (treatment), and 91% (virally suppressed).

Stigma, Discrimination, and Disclosure

• Treatment as Prevention (TasP) approach emphasizes the importance of early treatment to reduce HIV transmission.
• Pre-Exposure Prophylaxis (PrEP) is not intended for everyone, but for those at high risk of HIV infection.
• PrEP does not replace traditional risk-reduction strategies.

Post-Exposure Prophylaxis (PEP)

• PEP is a short course of antiretroviral therapy to prevent HIV acquisition after exposure.
• PEP should be started as soon as possible, and no later than 72 hours, after exposure.
• The global recommendation for PEP is a 3-drug regimen, including an integrase inhibitor, for 28 days.
• Almost all PEP is now 28 days of first-line ART (TLD: tenofovir disoproxil, lamivudine, and dolutegravir).

HIV Transmission Prevention

• Promote barrier protection (latex condoms and lubricant) during sexual encounters.
• Effective use of PrEP can prevent HIV transmission.
• Undetectable viral loads in serodiscordant sexual partners living with HIV (U=U) can prevent transmission.
• Harm reduction practices in people who inject drugs (PWID) can also prevent transmission.
• Strict adherence to universal precautions within the healthcare setting is essential.

Mother-Infant (Vertical) Transmission

• HIV can be spread to babies born to, or breastfed by, mothers infected with the virus.
• Prevention of Mother-To-Child Transmission (PMTCT) is a crucial aspect of HIV prevention.

Pathophysiology of HIV

• HIV is a single-stranded RNA retrovirus that infects and replicates with CD4 cells (T helper cells).
• The virus penetrates the host CD4 cell, empties its contents, and converts its RNA into DNA using reverse transcriptase.
• The viral DNA is combined with the host DNA using the enzyme integrase.

Phases of HIV Infection

• Primary infection: At seroconversion, the patient may experience flu-like symptoms, and CD4 levels fall in response to the initial, rapid replication of HIV.
• Latent phase: The infection enters a latent phase, and the patient may initially be asymptomatic, but with CD4 levels falling and viral load increasing.
• Chronic infection: The HIV infection can later become symptomatic and eventually develop into AIDS over an average of 10 years.

WHO Clinical Stages

• The WHO system for adults classifies patients into one of four hierarchical clinical stages ranging from stage 1 (asymptomatic) to stage 4 (AIDS).