Clinical Review

HIV Prevention: A 3-Pronged Approach

Author and Disclosure Information

 

References

Harm reduction is a collection of strategies meant to reduce complications of illicit drug use, including HIV transmission. These strategies include needle and syringe programs that provide injection drug users with sterile equipment, and opioid substitution therapy.

Needle and syringe programs decrease HIV transmission49 and risky behaviors related to injection drug use,50 but federal funding of such programs is prohibited. Opioid substitution therapy reduces the incidence of HIV,50,51 injection drug use, sharing of drug preparation and injection equipment, and drug-related behaviors associated with a high risk of HIV transmission.50,52 However, in the United States, the quality of these programs varies; a study of opioid substitution therapy delivery found that 22.8% of programs provided doses that were too low to be effective.53

In clinical trials of pre-exposure prophylaxis, drug resistance has been rare and mostly limited to those who had unrecognized acute HIV infection.

FDA-approved medications for opioid substitution therapy include sublingual buprenorphine, sublingual buprenorphine/naloxone tablets or strips (Suboxone), and oral methadone. Buprenorphine-based regimens can be provided by appropriately trained primary care clinicians; methadone requires a referral to a narcotic treatment program. TABLE 4 provides training and support resources for physicians who want to integrate opioid substitution therapy into their clinical practice.

CORRESPONDENCE
Richard Moore II, MD, 250 Smith Church Road, Roanoke Rapids, NC 27870; moorera2@gmail.com.

Pages

Recommended Reading

AAP: Most Parents Develop Vaccine Preferences Before Pregnancy
Clinician Reviews
Prophylactic Antibiotics Don’t Prevent Poststroke Pneumonia
Clinician Reviews
HIV: Still Epidemic After 30 Years
Clinician Reviews
Sterile or Nonsterile Gloves for Minor Skin Excisions?
Clinician Reviews
Shingles Vaccine Protection Lasted 5-6 Years in Autoimmune Disease Patients
Clinician Reviews
Pro-vaccine Community Outreach Campaign Appears Successful in Australia
Clinician Reviews
Study: Exposure History Critical to Design of Universal Flu Vaccine
Clinician Reviews
Acute and Recurrent Bacterial Vaginosis
Clinician Reviews
Say Ahh…
Clinician Reviews
Updates in Pediatrics
Clinician Reviews

Related Articles

  • Article

    HIV: 3 cases that hid in plain sight

    Having a high index of suspicion is key to recognizing the signs of HIV infection in patients without classic risk factors. How quickly would you...

  • Audio

    HIV: Clues that are easy to miss

    Jeffrey T. Kirchner, DO, FAAFP, AAHIVS, discusses clinical symptoms and abnormal lab findings of HIV that you might overlook in a patient who...