The new HIV guidelines outline low-cost prevention strategies for high-risk groups

- Dec 07, 2017 -

The new HIV guidelines outline low-cost prevention strategies for high-risk groups

Canada's new HIV guidelines outline how a new biomedical strategy to stop HIV infection can best be used in high-risk populations before and after exposure to the virus. The guidelines are published in the CMAJ journal, November 27, 2017, and are entitled "Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis." It applies to adults at risk of contracting HIV due to sexual activity or injecting drugs.

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Dr. Darrell Tan, a researcher at St. Michael's Hospital in Canada and an infectious disease specialist, and other paper authors wrote that "the huge economic costs of HIV infection and the lower age of these newly diagnosed infections (most of the new cases occur between 30 and 39 Old) stressed the economic importance and social importance of stopping the new infection. "

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Key strategies that are consistent with international AIDS guidelines include pre-exposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP). PrEP refers to the regular introduction of anti-HIV drugs before HIV exposure, whereas nPEP refers to taking antiretroviral drugs after exposure to HIV due to sexual activity or drug injections.

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The guidelines outline practical prevention advice in simple reference boxes for clinicians in primary care, infectious diseases, emergency medicine, nursing, pharmacy and other disciplines. Policymakers may also find it useful in formulating health care policies. This guideline was developed by the Biomedical HIV Prevention Working Group of the Canadian Institutes of Health (CIHR) Canadian HIV Clinical Trials Network and a team of 24 experts from different disciplines.

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In Canada, more than half (54%) of new infections occur in gay, bisexual and other men who have sex with men, and the population is estimated to have a 131-fold higher risk of infection than other men. In addition, drug users who inject drugs are estimated to be 59 times more likely to be HIV-positive than non-drug users. Compared with the general population in Canada, people from countries with HIV / AIDS have a 6.4-fold increase in the risk of HIV infection and a 2.7-fold increase in the risk of infection among indigenous peoples.

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These authors point out that the drugs used in PrEP and nPEP are usually very safe and effective, but these are not suitable for all people with an increased risk of HIV infection due to personal preferences or a rare risk of drug toxicity.

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Health Economics Analysis shows that the use of PrEP in high-risk groups is cost-effective in terms of health care expenditures.

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The authors write, "Drug costs so far have limited the viability and acceptability of these strategies, but the recently introduced generic TDF / FTC (tenofovir disoproxil / emtricitabine, The approval for use as an anti-HIV drug in PrEP and a major component of all nPEP regimens) and the growing public drug coverage in Canada for PrEP may have a significant impact on their use. "

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This guideline set by Canada is basically in line with international guidelines from the United Kingdom, the United States and Australia.

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The authors conclude, "We hope this guidance will lower Canada's health by improving the quality of care, increasing access to health care, reducing inappropriate changes in health care practices and fostering a rigorous assessment of Canada's national biomedical prevention strategy HIV infection rate. "