In addition to counseling on consistent condom use, pre-exposure prophylaxis with tenofovir-emtricitabine should be given to HIV-uninfected adults who are at high risk for sexually-acquired HIV and are committed to medication adherence and close follow-up. The drug combination is available in India. All high-risk patients should ask their doctors for the same.
In July 2012, the US FDA approved the combination for pre-exposure prophylaxis among confirmed HIV-negative individuals at high risk for sexually-acquired HIV infection.
Specific high-risk populations include the following:
- Men who have unprotected anal sex with men and have multiple or anonymous sex partners
- Heterosexual individuals who have multiple sex partners in areas of high HIV prevalence
- Partners of HIV-infected individuals who have not achieved viral suppression
Several trials have demonstrated a reduction in the risk of HIV infection by 48 to 75 percent with daily use of the above combination compared with placebo.
The combination drug should be given once daily and continued for as long as the risk of infection persists. If a decision is made to prescribe the drug it should be dispensed as a 90-day supply, renewable only after HIV testing.
Prior to initiation of pre-exposure prophylaxis, all patients should have HIV antibody testing to be certain that they do not have unsuspected chronic HIV infection.
Condoms are highly effective in preventing HIV transmission without the risk of systemic side effects and are an important aspect of any HIV prevention strategy.