PREVENTION AND

CONTROL OF AIDS

-Utsav Kumar Shrestha

Roll no.: S-22
Prevention of AIDS
Individuals can reduce the risk of
HIV infection by limiting exposure
to risk factors. 
Get tested and know your
partner’s HIV status: Talk to your
partner about HIV testing and get
tested before you have sex.

Have less risky sex: HIV is mainly

spread by having anal or vaginal
sex without a condom or without
taking medicines to prevent or treat
HIV.
• Use condoms: Correct use
of male and female
condoms during vaginal or
anal penetration protects
against the spread of STIs,
including HIV. Male latex
condoms have an 85% or
greater protective effect
against HIV and other
sexually transmitted
infections.
Limit your number of sexual
partners: The more partners you
have, the more likely you are to have
a partner with HIV whose HIV is not
well controlled or to have a partner
with an STD. Both of these factors can
increase the risk of HIV transmission.
Don’t inject drugs: But if you
do, use only sterile drug injection
equipment and water and never
share your equipment with
others.
Testing and counselling
for HIV and STIs:
Testing for HIV and other STIs is
strongly advised for all people
exposed to any of the risk
factors. This way people learn of
their own infection status and
access necessary prevention and
treatment services without
delay. 
Pre-Exposure Prophylaxis
(PrEP)
PrEP can help prevent HIV infection
in people who don’t have HIV but
who are at high risk of becoming
infected with HIV.
• PrEP is recommended for sero-discordant
couples , men who have sex with men
(MSM) and transgender people and it is
strongly recommended for men who have
sex with men.

• Furthermore, WHO recommends offering PrEP

to people at substantial risk of acquiring HIV
rather than limiting the recommendation to
specific populations.
• PrEP will be implemented with Tenofovir (TDF)
+ Emtricitabine (FTC) [Lamivudine (3TC)] - based
regimen and has to be taken once daily. During
PrEP, HIV and creatinine level tests will be done
every three months for the first 12 months.
When taken consistently, PrEP has
been shown to reduce the risk of
HIV infection in people who are at
high risk by up to 92%.

PrEP is a powerful HIV prevention

tool and can be combined with
condoms and other prevention
methods to provide even greater
protection than when used alone.
 POST EXPOSURE
PROPHYLAXIS (PEP)
PEP
FOR HIV
• Post-exposure prophylaxis (PEP) is
the use of ARV drugs within 72 hours
of exposure to HIV in order to
prevent infection. PEP includes
counselling, first aid care, HIV
testing, and administration of a 28-
day course of ARV drugs with follow-
up care.
INDICATIONS FOR PEP
• The exposed person is HIV negative.

• The source person is HIV positive, or at high

risk of recent infection and thus likely to be
in the window period.
• The exposure poses a risk of transmission, that
is:

1. Percutaneous exposure to potentially infectious

body fluids (infectious body fluids [viz. semen,
cervico-vaginal secretions, and blood] and
noninfectious body fluids [faeces, saliva, urine
and sweat]).
2. Sexual intercourse without an intact condom
3. Sexual assault
4. Exposure to non-intact skin or mucus
membranes to potentially infectious body
fluids.

• The exposure occurred less than 72 hours ago.

• The exposure is not part of chronic exposure

(prevention support needed instead).
 Drug Regimens for PEP
Adults and adolescents (>10 years)
Preferred regimen TDF + 3TC + LPV/r (or ATV/r)
Alternative regimen TDF +3TC* + EFV (or RAL or
DRV/r)
Children (≤ 10 years)
Preferred regimen AZT + 3TC + LPV/r
Alternative regimen TDF + 3TC or ABC+3TC with
NVP (or ATV/r, RAL for
<3years)
and EFV (or DRV/r for >3
years)
* AZT + 3TC in case of intolerance/contra indication to TDF
Elimination of Mother-to-
Child Transmission of HIV
 MTCT can be nearly fully
prevented if both the mother and
the baby are provided with ARV
drugs as early as possible in
pregnancy and during the period
of breastfeeding.
A comprehensive and integrated
four-pronged approach to
preventing HIV infection in women,
infants and young children is as
follows:
Prevent HIV infection among
women of childbearing age;
Prevent unintended pregnancies
among women living with HIV;
Prevent vertical HIV transmission
from infected mothers to their
children:
1.ART for mother and infant
prophylaxis
2.safer delivery practices
3.safer infant feeding choices
Provide appropriate treatment, care
and support to women living with HIV
and their children and families.
Prevention, Screening and
Management of TB among
adults
Among people living with
HIV/AIDS, TB is the most
frequent life-threatening
opportunistic infection and a
leading cause of death
accounting for about a third of all
mortality.
HIV care settings should
implement the WHO three I’s
strategy:
1.Intensified TB case finding
2.Isoniazid Prevention Therapy
(IPT)
3.Infection control at all case
encounters.
1. Intensified Case
Finding
As TB is one of the most common
opportunistic infection among the
HIV infected people, TB screening
should be performed on all new
HIV infected individuals,
2. Isoniazid Prevention
Therapy (IPT)
Preventive therapy against TB is
the use of anti-TB drugs in
individuals with latent
Mycobacterium tuberculosis
infection regardless of CD4 cell
count or ART status in order to
prevent the progression to active
disease.
IPT Regimen
For adults: Isoniazid 300mg daily
for 6 months along with Vitamin
B6 25mg/day (pyridoxine).
IPT Regimen
For children living with HIV who
are more than 12 months of age
and who are unlikely to have
active TB on symptom-based
screening and have no contact
with a TB case:
six months of IPT (10mg/kg/day).
3. TB treatment among
PLHIV (People living with
HIV)
All PLHIV with TB need ART.
AllHIV-infected patients with
diagnosed active TB should be
put on TB treatment immediately.
ART should be started in all TB
patients, including those with
drug-resistant TB, irrespective of
CD4 count.
Anti-tuberculosis treatment should
be initiated first, followed by ART as
soon as possible within the first 8
weeks of treatment (2 weeks, if
CD4<50 cells).
In all HIV-infected pregnant women
with active TB, ART should be
started as early as feasible, both for
maternal health and for elimination
of vertical transmission of HIV.
ARV drug choice in TB
coinfection
First-line treatment option is
TDF/3TC plus Efavirenz. Use AZT
if contraindication to TDF.
Use regular dose of Efavirenz
during ATT.
• Voluntary medical male circumcision (VMMC)
reduces acquisition of infection and the risk of
acquisition for men by up to 66% and offers
significant lifelong protection.