HIV Prevention

## Contact Hours: 3

This online independent study activity is credited for 3 contact hours at completion.

## Course Purpose

To provide healthcare professionals with knowledge of HIV and AIDS, common antiretroviral medications, transmission prevention, and CDC recommendations for pre-and post-exposure prophylaxis.

## Overview

Being a healthcare provider is not limited to nurses and physicians. According to the Center for Disease Control (CDC), a healthcare provider is anyone who has the potential of being exposed to HIV through blood and body fluids, equipment, or surfaces. Treatment of HIV and AIDS is ever-evolving with new medications. This learning topic provides an overview of HIV as described by the CDC, it’s history and stages, common antiretroviral medications that are currently used for pre-exposure and post-exposure prophylaxis, and CDC recommendations for the healthcare provider should exposure to HIV occur.

## Objectives

Upon completion of the independent study, the learner will be able to:

- Define HIV through a timeline of HIV identification in the United States.

- Describe Modes of HIV transmission.

- Describe common antiretroviral medications used to treat HIV.

- Identify post-exposure prophylaxis recommendations for healthcare providers as described by the Center for Disease Control.

## Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com. If you want to review our policy, [click here](/privacy-policy).

## Disclosures

Fast CE For Less, Inc. and its authors have no disclosures. There is no commercial support.

To access these Fast Facts, purchase this [course](/checkout/?add-to-cart=16597) or a [Full Access Pass](/cart/?add-to-cart=18311). If you already have an account, please [sign in here](/login).

To access this test, purchase this [course](/checkout/?add-to-cart=16597) or a [Full Access Pass](/cart/?add-to-cart=18311). If you already have an account, please [sign in here](/login).

Approximately 1.1 million people in the United States have human immunodeficiency virus (HIV) and approximately 15% of them do not know that they have the virus. It is estimated that approximately 40% of new HIV infections are transmitted by persons who are unaware that they have the disease.¹ Human immunodeficiency virus (HIV) is a virus that is spread through blood and body fluids, such as breast milk, semen, and vaginal fluids. The virus attacks the body’s immune system, specifically the CD4 cells. These cells are often called CD4+ T cells and are white blood cells that fight infection. The average range for CD4 count in a normal, healthy immune system is 500-1600 cells/millimeter (cells/mm³) of blood. When HIV enters and infects a CD4 cell, it begins to replicate, producing thousands of copies of the virus. The copies then enter and infect other CD4 cells and continue to replicate themselves and enter and infect other CD4 cells. The infected CD4 cells do not work appropriately and die early. The loss of CD4 cells results in a weakened immune system, making it harder for the body to remain healthy. Once the CD4 count falls below 200 cells/mm³, one is considered to have acquired immune deficiency syndrome (AIDS)³. AIDS is the most advanced form of infection caused by HIV, where the body has difficulty fighting infections and cancers. It can take 2-10 years, or longer for one diagnosed with HIV to develop AIDS when he or she does not take any antiretroviral medications. Most often, one with HIV will not develop AIDS if he or she begins antiretroviral medications soon after becoming infected. There is currently no cure for HIV, however if persons with HIV take their antiretroviral medications as prescribed, the amount of HIV in their blood (viral load) can become undetectable. Having undetectable levels of HIV will increase one’s life span, and one will effectively have no risk in transferring HIV to someone else through sexual contact. With correct medication adherence, one with HIV can live nearly if one who is not infected with HIV.

Human Immunodeficiency Virus (HIV) is believed to have originated in Kinshasa, in the Dominican Republic of Congo during the 1920s when it was transferred to hunters from chimpanzees. There was sporadic documentation of signs and symptoms related to the disease during early the 1970s, however, it is suggested that the current HIV epidemic began in the late 1970s. By the 1980s, between 100,000 and 300,000 were likely already infected. The following is a timeline of the evolution of HIV within the United States. ⁶

- In 1981 five gay men in Los Angeles were found to have a rare lung disease called Pneumocystis carinii pneumonia (PCP); a fungal lung infection that most often affects those who are immunosuppressed. By December, PCP was found in people who injected intravenous drugs. Pneumocystis carinii is now called Pneumocystis jirovecii, however the abbreviation PCP is still used to refer to the disease. The symptoms of PCP include: Cough

- Fever

- Chills

- Shortness of Breath

- Fatigue

- Chest pain

- In 1982 there were cases of immune-deficiency among sexually active gay men and the syndrome was named gay-related immune deficiency. The immune deficiency was also found in hemophiliacs, and later in the year the Center for Disease Control (CDC) termed the advanced form of the disease Acquired Immune Deficiency Syndrome (AIDS).

- In 1983 AIDS was found to be passed to heterosexual women from men infected with the disease. During this year, children were also found to be afflicted with AIDS, and it was concluded that the transfer of AIDS to children likely occurred from mothers during or shortly after birth. AIDS was also identified to be transferred in blood and body secretions, and transfer through social contact, water, food, surfaces, and air was ruled out. As a result, the center for disease control (CDC) was able to submit recommendations for disease prevention in health care professionals. International surveillance was also instituted by the World Health Organization (WHO).

- In 1984 the National Cancer Institute identified the retrovirus HTLV-III as the cause of AIDS. A blood test was also created to screen for the virus, and CDC recommended avoiding intravenous drug use and sharing of needles. Amsterdam was the first to initiate a needle and syringe exchange program to help reduce the rate of AIDS infections.

- In 1985 the Food and Drug Administration (FDA) licensed enzyme-linked immunosorbent assay (ELISA) testing. The test uses chemicals and components of the immune system to detect immune responses in the body. The availability of the test allowed blood banks to screen the blood supply for HIV infection. The United States Public Health Service also made recommendations for the prevention of mother-child transmissions of the virus.

- In 1986 the International Committee on the Taxonomy of viruses officially called the virus that causes AIDS human immunodeficiency virus (HIV).

- In 1987 the FDA approved the first antiretroviral drug zidovudine (AZT) to treat HIV. AZT belongs to a group of drugs known as nucleoside reverse transcriptase inhibitors (NRTIs) and is only active against HIV when the virus is replicating into viral DNA. The FDA also approved the western blot blood test, which is a more specific HIV antibody test than the ELISA test. During this year, the WHO also confirmed that HIV could be passed from mother to infant in breast milk.

- In 1988 the World Health Organization declared December 1 st world AIDS day.

- In 1989 the Center for Disease control released guidelines to prevent Pneumocystis carinii pneumonia (PCP).

- In 1990 the United States put into effect the Americans with Disabilities Act (ADA). The act prohibits discrimination against persons with HIV and disabilities.

- In 1993 the Center for Disease Control included recurrent pneumonia, invasive cervical cancer, and tuberculosis to the list of indicators of AIDS.

- In 1994 the FDA approved the first oral test not requiring blood to detect HIV.

- In 1995 the FDA approved saquinavir, the first protease inhibitor. The use of the medication resulted in approximately 60% reduction of AIDS related hospitalizations and deaths.

- In 1996 the FDA approved the first HIV home testing kit and HIV urine test.

- In 1997 the FDA approved Combivir; a combination drug within a single tablet. This made it easier for people with HIV to take their medications.

- In 2001 major drug companies began producing generic forms of HIV medications, making them more accessible in developing countries.

- In 2002 the FDA approved the first rapid HIV test which provides result within 20 minutes.

- In 2006 male circumcision was found to reduce the risk of female to male HIV transmission by as much as 60%.

- In 2011 early initiation of antiretroviral therapy was found to reduce the risk of HIV transmission by 96%. Antiretroviral therapy uses two or more drugs to treat HIV. Antiretroviral drugs are beneficial because they: Stop the virus from multiplying in the blood

- Increases the CD4 count, thereby improving the immune system function

- Slows down the progression of HIV to AIDS

- Prevents transmission of the disease

- Stops the virus from replicating in the blood

- In 2015 the World Health Organization created new guidelines for everyone living with HIV to receive antiretroviral treatment regardless of the CD4 count.

There are three stages in HIV infection. ⁷ Antiretroviral therapy (ART) can be used by those with HIV during each of the three stages of the disease. Taking medications as prescribed can slow the or prevent the progression of HIV, and having an undetectable viral load reduces the risk of HIV transmission to an HIV negative person. To be considered as having an undetectable viral load and significantly reduced risk of HIV transference, a person with HIV must have an undetectable viral load via blood laboratory draws consistently for six months or more.

- Stage One: Acute HIV infection

One may experience flu like symptoms within 2-4 weeks after HIV infection. These symptoms include fever, fatigue, sore throat, headache, sores in mouth, rash, and swollen lymph nodes. These symptoms are the body’s natural response to infection, however many people in stage one may not experience any symptoms at all. Although they may not experience symptoms, they are still contagious because there is a large amount of virus in their blood. Because one may be asymptomatic in this stage, the only way of determining HIV infection is through blood tests.

- Stage Two: Clinical Latency

Stage two is often called chronic or asymptomatic HIV infection. During this phase, the production of HIV is at low levels, and as a result one with HIV may not exhibit any symptoms. They are, however, still able to transmit the disease to others. One infected with HIV can remain in this stage for 10 years or more without the use of medications, but there is a possibility of someone progressing through stage two faster. When an individual with HIV is taking antiretroviral medications as prescribed, they may stay in stage two for decades, and even slow the production of HIV to a point that it is undetectable in the blood. An HIV positive person with undetectable levels of HIV poses virtually no risk of transmitting the disease during sex. When the production of HIV increases and the viral load goes up, one may begin to exhibit symptoms related to HIV. As the viral load goes up, the CD4 count will begin to decline, signifying the end of stage two and the entrance of stage three.

- Stage Three: Acquired Immune Deficiency Syndrome

AIDS is the most severe phase HIV. People with AIDS have compromised immune systems, and as a result are at higher risks for opportunistic infections and cancers. Common symptoms of AIDS include fever, chills, swollen lymph nodes, weight loss, weakness, and night sweats. AIDS is diagnosed when the CD4 count falls below 200 cells/mm³ or when opportunistic diseases and cancers such as pneumocystis carinii pneumonia or Kaposi sarcoma develop. Without antiretroviral treatment, a person with AIDS will typically survive 3 years. During this time, they can have a high viral load and be very infectious.

Opportunistic infections are infections that occur more frequently in people with weakened immune systems such as in HIV and AIDS. ⁹ Opportunistic infections are less common now than in the 1980s and 1990s because better medications and treatments are available. Although medications and treatments have greatly improved, many people with HIV still develop opportunistic infections because they may not know they are HIV positive, may not have a treatment regimen, or their treatment regimen may not be effective in keeping HIV levels low enough for the immune system to fight off infections. The following is a list of opportunistic infections listed by the CDC⁹:

HIV is spread from a person with HIV to a noninfected person through blood, semen, pre-seminal fluid, vaginal fluid, rectal fluid, and breast milk. For transmission to occur, the bodily fluids containing HIV must encounter damaged tissue or mucous membranes or be injected into the blood stream. It is not however, spread through tears, sweat, feces, urine, dry kissing, hugging, or insect bites. ⁷

37, 832 people were diagnosed with HIV in 2018.¹ The number of HIV infections decreased between 2010 and 2017, ⁶ however yearly diagnosis has increased among some groups. For instance, 68 % of those diagnosed were gay or bisexual men, 24% were heterosexuals, and 7% were people who injected drugs. Of the 68% of men considered gay or bisexual, 37% were African American, 27% were Caucasian, 30% were Hispanic, 3% were Asian, 2% were from multiple races, 1% was Native American, and <1% was Pacific Islander. Of the 24% that were heterosexuals, women accounted for 16 % of new HIV diagnoses and men accounted for 7%. The lowest group of new HIV infections occurred in people who injected drugs. Of the 7% in that group, 4% were men and 3% were women. Those between the ages of 25 and 34 were also shown to have the highest incidence of new transmission as shown in the table below¹:

HIV is most often spread by having unprotected anal or vaginal sex with an HIV infected person.¹ Receptive anal sex poses the highest risk because the lining of the rectus is thin and could allow entry of HIV from damaged tissue or mucous membranes. Insertive anal sex is also considered high risk for HIV transmission because HIV can potentially pass through the urethra, the foreskin in an uncircumcised male, open wounds, or scratches on the penis.

HIV can also be transmitted through vaginal sex. HIV can enter a woman during unprotected sex through mucous membranes that line the vagina and cervix. Men are also at risk of getting HIV from an HIV positive woman. Because HIV is in blood and vaginal fluid, it can pass through the urethra, the foreskin of an uncircumcised penis, scratches, cuts, and sores on the penis.

Oral sex involves putting the mouth on the vagina (cunnilingus), penis (fellatio), or anus (anilingus). For the most part, the risk of HIV transmission during oral sex is low. The risk of HIV transmission can be increased during oral sex if the man ejaculates into a mouth with bleeding gums, oral ulcers, or if genital sores or other sexually transmittable diseases are present during any form of oral sex. One can also get a sexually transmitted disease from oral sex. For instance, if anilingus is performed and feces enters the mouth, one is at increased risk for getting hepatitis A, hepatitis B, parasites, and bacterial infections.

HIV can be transmitted through the sharing of needles, syringes, and other injecting equipment. The transmission occurs when blood remains in a previously used needle or syringe. Depending on temperature and other factors, HIV can live in used needles, syringes, or other injecting equipment up to 42 days.

There are other rare cases of HIV transmission besides oral sex. For instance, blood transfusions have low risk of HIV transmission. There was a time in the 1980’s when the risk of HIV transmission through blood transmission was much higher, however the risk was drastically reduced with the implementation of rigorous testing of donated blood, organs, and tissues.

Being bitten by a person who is HIV positive also poses little risk of transmission, however the risks increased if there is extensive tissue damage and blood present at the site. If the skin is not broken, there is no risk for transmission of HIV. Likewise, deep open mouth kissing poses little risk of transmission, unless both people have sores or bleeding gums in their mouths, and blood from the HIV positive person gets into the blood stream of the HIV negative person.

A healthcare professional has little risk of HIV exposure or transmission when protective practices and personal protective equipment (when applicable) are utilized. The main risk that a healthcare professional may face is risk through a needle stick from an HIV contaminated needle, however the risk of transmission is less than 1%.

Transgender women and men are at high risk for getting HIV.² According to the CDC¹, approximately 14% of transgender women have HIV, and the percentage is much higher among black/African American (44%) and Hispanic/Latina (26%) transgender women. An estimated 3% of transgender men also have HIV. ²

Many transgender people face obstacles that make it harder to access HIV services, such as stigma and discrimination, inadequate employment or housing, and limited access to welcoming, supportive health care. Addressing these barriers is essential to the health and well-being of transgender people.

Increasing culturally appropriate, focused HIV testing efforts and care are key to preventing disparities and reducing HIV transmission in transgender communities. Having an early diagnosis and treatment regimen benefits everyone with HIV, and those HIV who take antiretroviral therapy as prescribed and are able stay virally suppressed can live long, healthy lives. They also have little risk of sexually transmitting HIV to partners.

Antiretroviral therapy (ART) reduces the HIV related mortality during all stages of HIV infections and reduces the rate of transmission to others.¹⁰ When taken as prescribed by s healthcare professional, ARTs can effectively suppress the viral load of HIV (sometimes to the point of being undetectable), maintain high levels of CD4, prolong survival by improving AIDS prevention, and reduce the risk of transfer of HIV infection to others.¹⁰ The CDC¹ recommends antiretroviral therapy medications be taken by everyone who is HIV positive, regardless of CD4 count. The plasma HIV RNA viral load should be monitored routinely to ensure appropriate response to antiretroviral therapy. When taken as prescribed, may HIV positive people achieve viral suppression within 6 months. The viral load should be tested within 2-4 weeks of initiation and every 4-8-week intervals until the viral load is undetectable or when the medication regimen is changed because of suboptimal response.³ Once the desired response to antiretroviral therapy is achieved, the viral load should be tested every 3-4 months for continued monitoring. When the viral load is proven to be suppressed for 2 years, the viral load can be tested every 6 months. ³ Occasionally, HIV positive persons with undetectable viral loads may experience a sporadic rise in the tests for viral load. When this occurs, they may need to use transmission prevention strategies such as condoms or pre-exposure prophylaxis until the viral load becomes undetectable again. Often, the viral load will be undetectable on the test.

The only practice that is 100% effective in preventing the transmission of HIV is abstinence. ¹ Abstinence occurs when one chooses to refrain from having oral, vaginal, and anal sex. Although the risk of getting HIV from oral sex is extremely low, there is a risk that is present. The risk for transmission during oral sex occurs when a man ejaculates into a partner’s mouth which has oral ulcers or bleeding gums, or when oral sex is performed in the presence of genital sores or other sexually transmitted diseases. Although the risk of transmission during oral sex is small, the risk of transmissions be further reduced with the use of a condom, which also reduces the risk of contracting sexually transmitted diseases such as gonorrhea of the throat and hepatitis. Condom use during vaginal and anal sex are also effective in reducing the risk of transmission of HIV.

Female and male condoms are available. The female condom is a thin pouch that is made up of synthetic latex that is called nitrile. It is worn by a woman in her vagina during sex and is comparable to the male condom in preventing HIV, sexually transmitted diseases, and pregnancy. The male condom is a thin layer of latex, polyisoprene, polyurethane, or natural membrane that is worn over the penis during sex. Like the female condom, latex is the most effective in preventing HIV transmission, sexually transmitted diseases, and pregnancy. For those who are allergic to latex, polyisoprene that is made of synthetic rubber, or polyurethane that is made of plastic are good options, but they are more prone to breaking than the latex condom. Natural membrane condoms have small pores and do not prevent the transmission of HIV or other sexually transmitted diseases. Water based and silicone lubricants can be used with a male condom, but oil-based lubricants such as Vaseline should not be used, because it can break down the lining of the latex condom, rendering it ineffective. Oil based lubricants can be used with the female condom without decreasing the effectiveness of the condom.

Pre-exposure prophylaxis (PrEP) are antiretroviral medications that are used by those who are HIV negative and have an increased risk of exposure to HIV through sexual activity or injectable drug use.¹⁰ When taken daily as prescribed, PrEPs greatly reduce the risk of HIV transmission through sexual contact by 99% and through injectable drug use by 74%. When the prescribed medications are not taken consistently, their efficacy in reducing the risk of HIV transmission greatly diminishes. They do require time for efficacy to build up in the system; pre-exposure prophylaxis reaches maximum protection from HIV at 7 days for receptive anal sex and 21 days for receptive vaginal sex and injectable drug use. There is no data available for insertive anal or vaginal sex efficacy¹. Pre-exposure prophylaxis medications must be taken daily for the duration of risk of HIV transmission. They can be stopped when the risk for HIV transmission decreases as a result in lifestyle changes, inability to PrEPs on a daily basis and another form of protection such as condoms is established, or when one has side effects to the medication that hinder its use. Side effects such as renal insufficiency and nausea have been documented with use of PrEPs, however the side effects have also been documented to diminish over time.¹⁰ An HIV test should be completed to confirm a negative HIV test prior to prescribing PrEP because resistant HIV can develop by administering PrEPs to one who is already HIV positive. The estimated creatine clearance should also be evaluated to confirm that it is ≥60 mL/minute prior to initiating therapy.³ Pre-exposure prophylaxis medications do not prevent the transmission of sexually transmitted diseases, in which case condom use is recommended. Pre-exposure prophylaxis medications also have not been shown to interfere with hormone therapy of transgender individuals and can be taken at the same time. Currently, Truvada is the only medication that is approved as a pre-exposure prophylactic to prevent the transmission of HIV. It is a combination drug that consists of tenofovir and emtricitabine and is commonly used in conjunction with other medications to treat HIV infection. Truvada works by blocking an enzyme called reverse transcriptase, HIV uses to copy its genetic material and reproduce.

Post-exposure prophylaxis (PEP) are antiretroviral medications that should be used by those who think they have been exposed to HIV through sex or injectable drug use.⁸ These medications are used to prevent HIV transmission and should be initiated within 72 hours of the possible exposure. They should be taken for 28 days; the frequency of medication use (daily or twice daily) is at the discretion of the prescribing provider⁸. Examples of recommended post-exposure prophylaxis regimens includes medications consisting of a dual nucleoside reverse transcriptase inhibitor (NRTI) backbone plus an integrase strand transfer inhibitor (INSTI), a protease inhibitor (boosted with ritonavir), or a non-nucleoside reverse transcriptase inhibitor.

Other antiretroviral drug combinations may be prescribed in specific cases, such as when one is exposed to a person who has drug resistant HIV. Post-exposure prophylaxis medications can be associated with severe side effects, and for this reason they should not be used when there is a negligible risk for HIV transmission. ⁸

A healthcare provider is anyone who works in the healthcare setting and is at risk for exposure to infectious materials such as blood, body fluids, tissue, contaminated equipment and medical supplies, and contaminated surfaces.⁸ The types of exposure that can place a healthcare provider at risk to HIV transmission include needle sticks, cuts from sharp objects, exposed nonintact skin that is chapped, cut, or has dermatitis that comes into contact with blood, body fluids, or tissues of an infected person. Cerebral spinal fluid, amniotic fluid, peritoneal fluid, synovial fluid, pericardial fluid, and pleural fluid all pose a potential risk of HIV infection. Unless visibly bloody, feces, urine, sputum, vomitus, tears and sweat are not considered infection.

There is a risk for HIV transmission to the healthcare provider who is punctured by a needle that is contaminated with HIV blood, however the risk is small at 0.3%.¹ Mucous membrane exposure yields 0.09% chance of transmission.¹ The risk for HIV exposure from nonintact skin is minimally quantifiable, but per the Center for Disease Control, the risk is less than mucous membrane exposure. The HIV transmission risk is increased when the healthcare provider is exposed to large quantities of HIV infected blood from needles that were placed in veins or arteries, or persons with high viral loads, such as in AIDS. The higher the viral load in the blood (even in a needle), the higher the risk for HIV transmission. The risk for HIV transmission also exists when one who is HIV positive has an undetectable viral load. This is because the HIV RNA (plasma viral load) is reflective of what is in the blood, however HIV is still present in infected cells despite treatment with antiretroviral drugs. The risk of transfer is small, but because a risk for HIV transmission exists, post-exposure prophylaxis should be offered to the healthcare provider who has been exposed.

The Center for Disease Control has recommendations for a healthcare provider’s occupational exposure to HIV. The recommendations are as follows¹⁰:

- Begin post-exposure prophylaxis as soon as possible (within 72 hrs.) of HIV exposure. The medications should be taken for four weeks. If after treatment the healthcare provider is found to not have acquired HIV, treatment and consultation can be discontinued.

- Determine the HIV status of the source to determine the need for post-exposure prophylaxis (when possible). It this is not feasible, begin post-exposure prophylaxis immediately.

- Post-exposure treatment regimens should include three different antiretroviral drugs prescribed by a specialist. The recommendation by the CDC for use of three-drug HIV Post-exposure prophylaxis regimens reflects. Studies that have demonstrated superior effectiveness of three medication regimens in reducing viral load in those with HIV when compared with two medication regimens.

- Concerns about a HIV source patient’s drug-resistance to medications that are commonly used for postexposure prophylaxis.

- New HIV medications safety and ability to be tolerated.

- The likelihood for better adherence to medication regimens because of fewer side effects.

- Expert consultation is recommended for any person exposed to HIV.

- Close monitoring of the exposed personnel should include counseling, baseline, and follow-up HIV testing, and monitoring for drug toxicity. The follow-up appointments should begin 72 hours after the regimen is began.

- If a newer generation combination HIV p24 antigen-HIV antibody is used for follow-up HIV testing may be completed 4 months after the exposure. If no newer test is available, HIV follow-up testing may be completed at 6 months.

Human immunodeficiency Virus (HIV) poses the risk of transmission through various activities such as sex, drug use, and occupational exposure. Multiple HIV prevention options are available and every healthcare provider who is exposed to or has HIV should learn about all options for the prevention of transmission. The benefits of ongoing treatment include supporting antiretroviral adherence, maintaining decreased viral load, and maintaining an increased CD4 count, which can lower the rates of HIV progression to AIDS, and improving overall health.Should a healthcare provider be exposed to HIV during occupational exposure, they should follow their institution’s recommendations for guidance, which has been set forth by guidelines created by the CDC. The guidelines include timelines and exceptions for testing, treatment regimens, and post-exposure monitoring. Healthcare providers should also take comfort in the low risk of HIV transmission during occupational exposure, as it is 0.3%¹ through needle puncture that is contaminated with HIV blood, and 0.09%¹ through mucous membrane exposure.

- About HIV/AIDS. (2019, December 2). Retrieved from https://www.cdc.gov/hiv/basics/whatishiv.html

- Becasen, J. S., Denard, C. L., Mullins, M. M., Higa, D. H., & Sipe, T. A. (2019). Estimating the prevalence of HIV and sexual behaviors among the US transgender population: A systematic review and meta-analysis, 2006–2017. American Journal of Public Health, 109(1), e1-e8. doi:10.2105/ajph.2018.304727

- Bernard M., B., S. Michele, O., Laura G., W., Berry, B., Barbara G., W., Kelly E., W., … Michael A., P. (2014). Laboratory testing for the diagnosis of HIV infection: Updated recommendations. doi:10.15620/cdc.23447

- Charles Patrick Davis, MD, PhD. (n.d.). ELISA test results, types & procedure risks. Retrieved from https://www.medicinenet.com/elisa_tests/article.htm

- Guidelines for prophylaxis against pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. (2001, May 2). Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/00001409.htm

- History of HIV and AIDS overview. (2019, October 10). Retrieved from https://www.avert.org/professionals/history-hiv-aids/overview

- HIV basics. (2019, September 25). Retrieved from https://www.cdc.gov/hiv/basics/index.html

- Kuhar, D. T., Henderson, D. K., Struble, K. A., Heneine, W., Thomas, V., Cheever, L. W., … Gomaa, A. (2013). Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for Postexposure prophylaxis. Infection Control & Hospital Epidemiology, 34(9), 875-892. doi:10.1086/672271

- Opportunistic infections | Living with HIV | HIV basics | HIV/AIDS | CDC. (2019, September 26). Retrieved from https://www.cdc.gov/hiv/basics/livingwithhiv/opportunisticinfections.html

- Prescribe PrEP pre-exposure prophylaxis. (n.d.). Retrieved from https://www.cdc.gov/stophivtogether/library/prescribe-hiv-prevention/brochures/cdc-lsht-php-brochure-prep-faq.pdf

- Sabin, C. A., & Lundgren, J. D. (2013). The natural history of HIV infection. Current Opinion in HIV and AIDS, 1. doi:10.1097/coh.0b013e328361fa66

To access this evaluation, purchase this [course](/checkout/?add-to-cart=16597) or a [Full Access Pass](/cart/?add-to-cart=18311). If you already have an account, please [sign in here](/login).

To access this test, purchase this [course](/checkout/?add-to-cart=16597) or a [Full Access Pass](/cart/?add-to-cart=18311). If you already have an account, please [sign in here](/login).

## FAQs

### How can HIV be prevented?

HIV can be prevented through safe sex practices such as consistent condom use, regular HIV testing, and taking pre-exposure prophylaxis (PrEP) if at risk. Needle exchange programs and harm reduction strategies also reduce transmission among people who inject drugs. Education and awareness campaigns help at-risk populations understand and manage HIV risk factors.

### What is treatment as prevention HIV?

Treatment as prevention (TasP) refers to using antiretroviral therapy (ART) to suppress viral load in people living with HIV. When viral load is undetectable, the risk of transmitting HIV to others is effectively zero. TasP works alongside routine HIV testing and medication adherence to reduce community transmission.

### What are the new HIV prevention methods?

New HIV prevention methods include pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), as well as long-acting injectable ART. Rapid HIV testing and early treatment also help prevent transmission. Public health programs increasingly focus on education, stigma reduction, and community outreach to high-risk populations.

### What are 7 ways HIV is not transmitted?

HIV is not transmitted through casual contact such as hugging, shaking hands, sharing utensils, toilet seats, saliva, tears, or mosquito bites. It only spreads through blood, sexual fluids, or from mother to child during birth or breastfeeding if precautions aren’t taken. Understanding these non-transmission routes reduces stigma and fear.

### What are the first signs of HIV?

The first signs of HIV can include flu-like symptoms such as fever, fatigue, swollen lymph nodes, sore throat, and rash. These early symptoms often appear 2–4 weeks after exposure and may be mild or go unnoticed. Routine HIV testing is essential because many people don’t recognize early signs.

### What is the best HIV prevention?

The best HIV prevention combines multiple strategies: consistent condom use, regular HIV testing, pre-exposure prophylaxis (PrEP), and treatment as prevention (TasP) for those living with HIV. Education, awareness campaigns, and safe needle programs also play a critical role in reducing HIV risk.

### Can HIV be transmitted from mother to child?

Yes, HIV can be transmitted from mother to child during pregnancy, birth, or breastfeeding if precautions aren’t taken. Antiretroviral therapy (ART) for the mother and HIV testing during pregnancy can dramatically reduce vertical transmission. Proper medical care and treatment adherence ensure the baby has a very low risk of HIV infection.

### How effective is PrEP in preventing HIV?

Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV transmission when taken consistently. It works especially well for high-risk populations and those engaging in safe sex practices but still at risk. Combining PrEP, regular HIV testing, and condom use provides the best HIV prevention strategy.