Today, there is an arsenal of ‘diversified prevention’, with condoms of course, but also pre-exposure preventive treatment (PrEP) and post-exposure treatment (PET). Until now, PrEP was almost exclusively given to men who had sex with men with whom they had multiple partners. The French National Health Authority or HAS (Haute Autorité de Santé) explicitly requests that it be extended ‘to all situations considered to be at risk of exposure to HIV, whatever the gender or sexual orientation of the individuals concerned’.
As a general rule, treatment should be started within 14 days of the initial diagnosis of HIV infection. However, in the case of primary infection or discovery of HIV infection during pregnancy in the 3rd trimester, treatment should be started immediately. Conversely, in the case of an immune deficiency justifying prior testing for certain opportunistic infections, the start of treatment may be deferred pending the results.
The HAS recommends that, wherever possible, ARV treatment should be initiated by taking a single daily tablet, which has the advantage of being easier to take, making compliance easier.
In the event of virological success, it should be considered whether the treatment should be adapted to improve tolerance or simplify administration.
HIV is regularly associated with infectious complications. The most common in our country are pneumocystis, bacterial pneumonia (particularly pneumococcal), tuberculosis, candida infections, herpesviridae infections and toxoplasmosis. Cryptococcosis, non-tuberculous mycobacterial infections, progressive multifocal leukoencephalopathy, lacryptosporidiosis and microsporidiosis may occur more rarely in advanced stages of immunodepression.
Depending on the blood level of CD4 T lymphocytes, primary or secondary prophylaxis may be proposed for certain infections:
These prophylaxes can be interrupted when the immune system has recovered sufficiently under antiretroviral treatment.
The HAS has published detailed recommendations for the most common infectious complications associated with HIV infection. For more details, you can access the recommendation ‘Management of infectious complications associated with HIV infection’ (in French).
All pregnant women living with HIV should receive optimal virological control to avoid the risk of transmitting HIV to their child during pregnancy and childbirth.
The HAS has announced that dolutegravir can now be used as an antiretroviral treatment at all stages of pregnancy, as an alternative to raltegravir or darunavir. A major new development was the announcement that breast-feeding was now possible for women who wished to do so, provided virological control was optimal, and with the proposal to extend antiviral prophylaxis for infants for the duration of breast-feeding to prevent any risk of residual transmission.
For more details, particularly on treatments, you can access the recommendation ‘Pregnancy and HIV: the desire to have a child, care of the pregnant woman and prevention of mother-to-child transmission’ (in French).
Article translated from the original French version by our partners in esanum.fr