« HIV infection is still active in France and there are still too many late diagnoses “, even though treatment options have multiplied, alerts the High Authority for Health (HAS). Nearly 25% of infections are still discovered at an advanced stage, due to a lack of screening. The updating of its recommendations for the care of people affected by the virus therefore aims to help health professionals to propose the best possible therapeutic strategies. They include “ new pre- and post-exposure preventive treatments, gyneco-obstetric and pediatric aspects, the specificities of antiretroviral treatments and infectious complications associated with HIV infection. » They are aimed at all health professionals who support people living with HIV, but also at the latter, at people at risk, and more generally at all users.
Strengthen prevention
The HAS first emphasizes the need to strengthen prevention and screening actions among those most exposed to infection, in particular by facilitating access to existing means of protection: condoms, but also PrEP or post-treatment. exhibition (TPE). “ Pre-exposure preventive treatment (PrEP) for HIV infection is very effective and should be offered widely to people at risk of being infected. », she recalls. She recommends extending it beyond multi-partner men who have sex with men (MSM).which currently represent almost all prescriptions, for all situations considered to be at risk of exposure to HIV. Including women who are pregnant, breastfeeding or on hormonal contraception. As for TPE, the combination of tenofovir disoproxil fumarate (TDF), lamivudine (3TC) and doravirine is now preferred in first instance. “ Finally, after a sexual exposure accident, a TPE/PrEP sequence is recommended », she adds.
Reminder of therapeutic strategies in case of infection
With regard to antiretroviral treatments (ARV), the HAS recalls that it is essential that “ any pregnant woman living with HIV » can have access to it, to preserve their health but also to prevent transmission to their child. « Optimal virological control in the mother helps eliminate the risk of HIV transmission to the child during pregnancy and childbirth », She emphasizes, recommending the use of dolutegravir, whatever the stage of pregnancy.
More generally, “ Early initiation of ARV treatment in a person living with HIV (PLHIV) is of major interest in reducing HIV-associated morbidity and mortality, preventing HIV transmission and improving or maintaining quality of life. » This must begin within 14 days following the announcement of the diagnosis, in the form of taking a single daily tablet. In the event of a primary infection or discovery of the infection during the 3rd trimester of pregnancy, treatment can be taken without delay, she adds. Finally, any treatment can be adapted “ to improve and preserve the person’s quality of life ». « Generally speaking, it is a question of individualizing the optimal combination to gain in tolerance or ease of administration, while maintaining immuno-virological effectiveness, without compromising the effectiveness of any subsequent treatment. “, she specifies.
Access the HAS recommendations
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