Let’s start a discussion about HIV prevention using this real-life case.
D. M. is a 27 yo African-American woman who was diagnosed with HIV 5-years ago. Her 3-year old son was born HIV negative. She is currently virally suppressed on a regimen of Triumeq. She married 3 months ago. Her husband has spoken to her doctor about starting PreP. After screening tests were done, he has come into the office to start the regimen.
This case illustrates 3 ways that HIV medicines can be used to protect from the spread of HIV.
D.M. currently takes her medicines properly and she has no detectable virus in her blood. Her HIV status was known when she was pregnant so the medicines prevented the baby from getting infected.
We learned over 25 years ago that the HIV drug zidovudine (AZT) can reduce the risk of an HIV-infected woman transmitting the infection to her baby. The combination treatments we use today are even more effective. In developing countries, maternal transmission of HIV infection to infants is still a serious problem, but efforts to screen mothers and start therapy have dramatically reduced infections in newborns. The babies may receive medications to protect them during breastfeeding.
So now D.M. must protect her husband from getting infected. Condoms may not be practical in a marriage. One way is to keep the virus under control by taking her medications. D.M. and her husband are a serodiscordant couple, meaning one partner is HIV- positive and the other partner is HIV-negative. In large, well-designed studies with serodiscordant couples, when the HIV+ partner was