Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
Midwifery Institute at Jefferson University, Philadelphia, Pennsylvania.
J Midwifery Womens Health. 2021 May;66(3):322-333. doi: 10.1111/jmwh.13231. Epub 2021 Jun 4.
HIV infection is a major public health problem for women in the United States. Prevention of new HIV infections is essential to the goal of eliminating HIV in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method recommended for women at increased risk for HIV infection, including during pregnancy and lactation. The recommended PrEP regimen is a fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine administered as a single daily dose. The initial evaluation for individuals desiring PrEP for HIV prevention includes obtaining a history, laboratory evaluation, and evaluation of the accessibility and acceptability of PrEP. Individuals using PrEP medications are seen every 3 months for follow-up. These follow-up visits include evaluation for signs and symptoms of seroconversion, management of side effects and adverse reactions, and evaluation of adherence to PrEP. Follow-up visits also include testing for HIV, sexually transmitted infections, and renal function and a review of HIV prevention and risk reduction methods. Despite known safety and efficacy of PrEP among women, PrEP use in women in the United States remains low. Gaps exist in HIV prevention that can in part be addressed by women's health care providers through risk screening and provision of HIV prevention methods. All providers of comprehensive sexual health care can and should assess individuals for risk factors for HIV infection and offer HIV prevention methods, including PrEP, to individuals at risk for HIV.
HIV 感染是美国女性面临的一个主要公共卫生问题。预防新的 HIV 感染对于实现美国消除 HIV 的目标至关重要。暴露前预防（PrEP）是一种有效且安全的 HIV 预防方法，推荐给有感染 HIV 风险增加的女性使用，包括在怀孕期间和哺乳期。推荐的 PrEP 方案是富马酸替诺福韦二吡呋酯和恩曲他滨的固定剂量组合，作为每日单剂量给药。希望通过 PrEP 预防 HIV 的个人的初始评估包括获取病史、实验室评估以及评估 PrEP 的可及性和可接受性。使用 PrEP 药物的个人每 3 个月进行一次随访。这些随访包括评估血清转化的迹象和症状、管理副作用和不良反应，以及评估 PrEP 的依从性。随访还包括 HIV、性传播感染和肾功能检测，并回顾 HIV 预防和降低风险方法。尽管 PrEP 在女性中的安全性和有效性已得到证实，但美国女性对 PrEP 的使用仍然很低。HIV 预防方面存在差距，部分可以通过妇女保健提供者通过风险筛查和提供 HIV 预防方法来解决。所有提供全面性健康护理的提供者都可以而且应该评估个人感染 HIV 的风险因素，并向有感染 HIV 风险的个人提供 HIV 预防方法，包括 PrEP。
