I recently attended a lecture on HIV in Nevada. Nevada is way ahead of the nation (read this: we are risky!) HIV Incidence rate is 20 people per 100,000. The national average is 12. Nevada has one of the highest rates of HIV in the country.
Many people who live with HIV do NOT know that they have it. 40% of new infections are transmitted by people who do not know that they have the virus. This is why widespread screening should be done.
HIV and STIs go hand-in-hand. In addition to high HIV rates, Nevada has one of the highest rates of syphilis and chlamydia infections. Infections are often without symptoms, get tested!
There is a national HIV/AIDS strategy for the USA. This was started in 2010. There are 3 overarching goals:
- Reduce new HIV infections
- Improve health outcomes for those living with HIV
- Reduce HIV-related disparities
“Continuum of care” in HIV reveals our goals with HIV patients. Once a person is diagnosed with HIV, the patient is encouraged to receive HIV care, retain them in HIV care, prescribing antiretroviral therapies, achieving viral suppression.
How are Nevadans doing? Not well. Nevada’s continuum of care shows that of those diagnosed in Nevada with HIV only 81% were “linked to care.” This means 19% of HIV patients do not see a healthcare provider. Of the 81% who initially saw a physician, only 28% of patients retain their healthcare relationship. This means only 28% of patients are getting viral loads and medication. 26% of those with HIV in Nevada have reached viral suppression. When the virus is suppressed, this decreases the risk of viral transmission to others. So, viral suppression is the goal!
How can we end the HIV epidemic?
U = U. Undetectable = Untransmissable. The data is incredible relating to this. Thousands of sex acts have been studied and those HIV positive patients on effective HIV treatment with undetectable viral loads will not pass HIV on with sex.
Treatment as Prevention. Patients need access to testing and treatment. Support needs to be available to maintain viral suppression as this will help retention. Need access to viral load monitoring. This needs resources.
PrEP. Pre-Exposure Prophylaxis. This is for patients who are HIV negative which means patients need to know their HIV status. They take one pill a day. Two medications are in this one pill and there are two brands of pills with different doses of the two active medications. It is 99% effective. PrEP use in HIV-negative-Nevada is only 1% of the population, many don’t know that there is a VERY effective pill. Truvada or Descovy
nPEP. Non-occupation Post exposure Prophylaxis. (This is NOT a healthcare worker who has a needlestick). This must be started within 72 hours of exposure. 28 day treatment (Truvada plus Raltegravir). Highly effective. Minimal side effects. Does this patient want to start on PrEP after their 28 day treatment to decrease their risk of contracting HIV in the future?
STI (sexually transmitted infections). Those with STIs are more at risk for HIV. What body parts should be tested? 3 site testing: oral, rectal, urine-based. Because different body parts are being used to have sex, all 3 need to be tested. Oral and rectal swabs can be done very effectively by the patient. We miss 95% of gonorrhea and 73% of chlamydia because we often do not do 3 site testing.
Why is the way sex is performed important? There are different risks of contracting HIV from a partner depending on the manner of sex. Receptive anal sex has 1.4% risk per episode which is remarkably higher than any other manner. Insertive anal sex is 0.06 to 0.62%. Receptive vaginal sex is 0.08%.