N ORTHWEST AIDS E DUCATION AND T RAINING C ENTER HIV Prevention in Clinical Care Settings Jeanne Marrazzo, MD, MPH Professor, Division of Allergy and Infectious Diseases University of Washington

Jeanne M. Marrazzo, MD, MPH; Carlos del Rio, MD; David R. Holtgrave, PhD; Myron S. Cohen, MD; Seth C. Kalichman, PhD; Kenneth H. Mayer, MD; Julio S. G. Montaner, MD; Darrell P. Wheeler, PhD, MPH; Robert M. Grant, MD, MPH; Beatriz Grinsztejn, MD, PhD; N. Kumarasamy, MD, PhD; Steven Shoptaw, PhD; Rochelle P. Walensky, MD, MPH; François Dabis, MD, PhD; Jeremy Sugarman, MD, MPH; Constance A. Benson, MD HIV Prevention in Clinical Care Settings: 2014 Recommendations of the International IAS-USA-Society Panel Marrazzo et al, JAMA, 2014.

Slide 3 of 34 HIV Prevention in Clinical Care Settings: 2014 Recommendations of the International Antiviral Society-USA Panel Free web access to the paper at jama.com

IAS-USA HIV Prevention Recommendations: Goal Worldwide, ~2.3 million new HIV infections in 2012 ─In US, ~50,000 new HIV infections each year—largely unchanged since the 1990s Integrated biomedical and behavioral HIV prevention tools and ART for treatment offer chance to curb the HIV epidemic Clinicians play a crucial role in implementing combination HIV prevention interventions These recommendations seek to consolidate best practices for clinicians across a range of HIV prevention issues Marrazzo et al, JAMA, 2014.

HIV Continuum of Care Source: CDC, 2013 and Holtgrave et al, 2012 General population: 9.2% engaging in risk behaviors HIV-positive: 1,144,500 Diagnosed with HIV: 963,600 Diagnosed with HIV as of 2010: 50.9% retained in care Diagnosed with HIV as of 2010: 327,485 with viral load <200 copies/ml Diagnosed with HIV in 2011: 79.8% linked to care General population: 9.2% engaging in risk behaviors HIV-positive: 1,144,500 Diagnosed with HIV: 963,600 Diagnosed with HIV in 2011: 79.8% linked to care Diagnosed with HIV as of 2010: 50.9% retained in care Diagnosed with HIV as of 2010: 327,485 with viral load <200 copies/ml ~50K new infections per year28.6% virologically suppressed

IAS-USA HIV Prevention Recommendations: Sections HIV Testing and Knowledge of Serostatus Prevention Measures for HIV-Infected Individuals Prevention Measures for HIV-Uninfected Individuals Prevention Issues Relevant to All Persons With or At Risk for HIV Infection Marrazzo et al, JAMA, 2014

Summary After 30 years there is potential for an AIDS-free generation Clinicians are instrumental in achieving this and can ─Offer all adults and adolescents HIV testing ─Regularly assess substance use and sexual risk practices in HIV-infected patients and those at risk for infection ─Offer ART and adherence support at diagnosis of HIV infection and PrEP and adherence support to patients at high risk for HIV infection ─Be alert to the nonspecific presentation of acute HIV infection ─Emphasize and support linkage to care ─Provide or refer for individualized risk-reduction counseling for HIV-infected patients and those at risk for infection ─Conduct regular STI screening HIV-infected patients and those at risk of infection Marrazzo et al, JAMA, 2014

HIV Testing and Knowledge of Serostatus Marrazzo et al, JAMA, 2014.

HIV Testing and Knowledge of Serostatus (cont’d) Marrazzo et al, JAMA, 2014.

HIV Testing and Knowledge of Serostatus (cont’d) Marrazzo et al, JAMA, 2014.

Antiretroviral Therapy Marrazzo et al, JAMA, 2014.

Counseling on Risk Reduction, Disclosure of HIV Serostatus, and Partner Notification Marrazzo et al, JAMA, 2014.

Needle Exchange and Other Harm Reduction Interventions Marrazzo et al, JAMA, 2014.

Risk Assessment and Risk Reduction for HIV Infection Marrazzo et al, JAMA, 2014.

Efficacy of Biomedical Interventions to Prevent HIV Acquisition: Summary of the Evidence from Randomized Clinical Trials Modified from Ambitious Treatment Targets: Writing the Final Chapter of the AIDS Epidemic, UNAIDS, 2014.

Preexposure Prophylaxis (PrEP) Marrazzo et al, JAMA, 2014.

Preexposure Prophylaxis (cont’d) Marrazzo et al, JAMA, 2014.

Preexposure Prophylaxis (cont’d) Marrazzo et al, JAMA, 2014.

Postexposure Prophylaxis (PEP) Marrazzo et al, JAMA, 2014.

Screening and Treatment for STIs Marrazzo et al, JAMA, 2014.

Screening and Treatment for STIs (cont’d) Marrazzo et al, JAMA, 2014.

Thanks!

IAS-USA HIV Prevention Recommendations: Rating System

Strategies for Promoting Movement Through the Continuum of HIV Care Marrazzo et al, JAMA, 2014.

Reproductive Health Care/ Hormonal Contraception

Voluntary Medical Male Circumcision Marrazzo et al, JAMA, 2014.