Gladstone Institutes and University of California , San Francisco ; San Francisco AIDS Foundation , California.
Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta, Georgia.
Open Forum Infect Dis. 2015 Aug 26;2(4):ofv126. doi: 10.1093/ofid/ofv126. eCollection 2015 Dec.
Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for postexposure prophylaxis (PEP), pre-exposure prophylaxis (PrEP), and treatment of HIV infection. We reviewed research evidence and current normative guidelines to identify best practices for integrating these high-impact prevention strategies. More sensitive HIV tests used for screening enable earlier diagnosis and treatment of HIV infection, more appropriate counseling, and help limit drug resistance. A fully suppressive PEP regimen should be initiated based on exposure history or physical findings when sensitive diagnostic testing is delayed or not available and antibody tests are negative. Transitions from PEP to PrEP are often warranted because HIV exposure events may continue to occur. This algorithmic approach to integrating PEP, PrEP, and early treatment decisions may increase the uptake of these interventions by a greater number and diversity of knowledgeable healthcare providers.
根据研究证据和现有规范指南，建议采用最佳实践将人类免疫缺陷病毒 (HIV) 检测和抗逆转录病毒干预措施整合用于预防和治疗。目的是在高风险时期提供高影响力的预防服务。推荐使用抗逆转录病毒药物进行暴露后预防 (PEP)、暴露前预防 (PrEP) 和 HIV 感染治疗。我们回顾了研究证据和当前规范指南，以确定整合这些高影响力预防策略的最佳实践。用于筛查的更敏感的 HIV 检测可实现 HIV 感染的更早诊断和治疗、更适当的咨询，并有助于限制耐药性。当敏感诊断检测延迟或不可用时，或抗体检测阴性时，应根据暴露史或体检结果启动完全抑制性 PEP 方案。从 PEP 过渡到 PrEP 通常是必要的，因为 HIV 暴露事件可能会继续发生。这种整合 PEP、PrEP 和早期治疗决策的算法方法可以提高更多有知识的医疗保健提供者对这些干预措施的接受度。
