_______________________________________________________________________ HIV/AIDS: An Update
Oral postexposure prophylaxis is available as a fixed-dose combination tenofovir and emtricitabine (Truvada or Descovy) taken daily for <90 days. Injection PrEP consists of one dose of cabotegravir followed up by a dose four weeks later, and then every eight weeks thereafter [62]. No other antiretroviral regimens should be used for pre-exposure prophylaxis. All patients prescribed PrEP must have a negative HIV test prior to initiating treatment and every three months thereafter for oral PrEP, and every two months for patients receiving cabotegravir injections. In addition, patients should be advised regarding possible side effects and the continued necessity for safe sex practices [62]. Advances in PrEP continue to be made to alleviate the bur- den of care. As noted, in 2022, the FDA approved injectable lenacapavir (Sunlenca), the first capsid inhibitor, for the treat- ment of HIV-1 infection [43]. As of early 2025, lenacapavir is under FDA priority review for use as the first twice-yearly PrEP option [59]. HIV/AIDS VACCINE Both preventive and therapeutic vaccines are being studied for use in the fight against HIV. Preventive vaccines are developed to protect individuals from contracting HIV, while the goal of therapeutic vaccines is to boost immune response to and better control existing HIV infection. Of course, the ultimate goal in vaccine research is a vaccine that will prevent infection; however, despite many trials, no vaccine effective in preventing HIV has been discovered. Most progress on HIV vaccine development may be monitored through the International AIDS Vaccine Initiative (IAVI) at https://www.iavi.org/our-work/hiv-vaccines. The IAVI, in collaboration with partners in the public, private, and phil- anthropic sectors, develops vaccines and antibodies to address urgent, unmet global health challenges, including HIV, TB, emerging infection diseases, and neglected diseases [63]. TOPICAL MICROBICIDES Because HIV is spread predominantly through sexual transmis- sion, the development of chemical and physical barriers that can be used intravaginally or intrarectally to inactivate HIV and other STI pathogens is critically important for controlling HIV infection.
Researchers are developing and testing new creams or gels (topical microbicides) that could be applied before intercourse to protect individuals against HIV and other sexually transmit- ted organisms [64]. One of the most promising is 1% vaginal gel formulation of tenofovir, which showed a 54% decrease in the incidence of HIV infection in high adherers in one clinical trial [65]. Another option is a flexible silicone matrix polymer ring containing dapirivine, an NNRTI, which is slowly released over the course of one month [64]. However, there are concerns regarding compliance with recommendations to ensure protection. New topical microbicide candidates would ideally be non- irritating and inexpensive. In addition, they should be avail- able in both spermicidal and non-spermicidal formulations, so women do not have to put themselves at risk for acquiring HIV and other STIs in order to conceive a child. EDUCATION TO PREVENT HIV INFECTION Many adolescents engage in behaviors that put them at risk for HIV infection. According to the CDC, in 2023, 48.1% of sexually active high school students had not used a condom during last sexual intercourse and 1.2% had injected an illegal drug [66]. In an analysis of the Youth Risk Behavior Survey, researchers found that 84% of adolescents report having received education on HIV prevention in school. Among those students, it was found that HIV education was associated with increased rates of abstaining from substance use during intercourse. Further, for boys, receiving HIV education was associated with increased condom use at last sexual encounter, as well as increased rate of testing for HIV [67]. This evidence highlights HIV education as a promising intervention for risk behavior reduction. While the availability of HIV prevention education is important, the quality and content may not pro- vide adequate information on the subject or may not provide necessary opportunities for confidential discussions or targeted counseling. Healthcare professionals have a unique opportu- nity to intervene in this population to provide accurate and complete information on HIV transmission and risk reduction.
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MDCT2026
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