Despite the success of antiretrovirals, the AIDS stage and its complications have not disappeared. Nearly 25% of HIV infections in France are discovered at an advanced stage. “It appears necessary to strengthen targeted and repeated prevention and screening actions in the most exposed populations, while continuing systematic screening in the general population, at least once in a lifetime when seeking care,” notes the High Health Authority (HAS).
PrEP, a prevention tool in its own right
The basis of prevention consists of allowing people at risk of infection to adopt at least one of the tools from the range of means that have shown their effectiveness. In particular the condom (internal and external), post-exposure treatment (PET) after a risky relationship, pre-exposure prophylaxis (PrEP), taken continuously or before and after unprotected sexual practice.
In its latest good practice recommendations, the HAS reaffirms the importance of pre-exposure prophylaxis (PrEP) as a particularly effective prevention tool in its own right. It recommends the need to expand PrEP beyond men who have sex with men with multiple partners who currently account for almost all prescriptions. “Women represent 32% of new infections in 2021 but only 2.5% of new PrEP initiations; we have succeeded in reaching the urban and educated MSM public, but we have a blind spot among women, among trans people, among people in great precariousness”, summarized the infectious disease specialist in 2022 for the International Journal of Medicine (JIM). Gilles Pialloux, head of the infectious diseases department at Tenon hospital (Paris).
The use of PrEP, which any doctor can prescribe, must be systematized “in all situations considered to be at risk of exposure to HIV regardless of the gender and sexual orientation of the person”. MSM, transgender women, serodifferent heterosexual couples, exposed general population, intravenous drug users, PrEP has proven itself for all these population categories. “The occurrence of HIV infection while on PrEP is rare, and mainly linked to poor compliance with preventive treatment; it requires rapid specialist advice. »
PrEP as a complement to TPE?
Another prevention tool, better known than PrEP, is post-exposure treatment (PET). Note that after intercourse with an HIV-positive person, TPE is not indicated when the partner living with HIV has had antiretroviral treatment for more than 6 months and a last undetectable viral load (
HIV-AIDS: physical activity, an everyday ally
