HIV Infection: What Is New in Prevention and Treatment?

HIV remains a significant public health challenge despite highly effective prevention and treatment strategies. Screening for HIV infection is recommended for individuals ages 15 to 65 years. The status neutral approach to care includes preexposure prophylaxis for HIV-negative patients and antiretroviral therapy for patients with HIV. The preexposure prophylaxis options approved by the US Food and Drug Administration include oral and injectable formulations, which reduce HIV acquisition risk by 99% when taken consistently. Same-day antiretroviral therapy initiation is the standard of care for patients diagnosed with HIV infection, with integrase strand transfer inhibitor–based regimens preferred for treatment-naive patients. Key clinical considerations in primary care require modified management approaches for patients with HIV. All patients 40 to 75 years of age with HIV infection and 10-year atherosclerotic cardiovascular disease risk scores between 5% and less than 20% should be prescribed a moderate-intensity statin, and those with risk scores of 20% or greater should receive a high-intensity statin. In addition to standard age-appropriate vaccines, adults with HIV should receive hepatitis A and B (if not immune), meningococcal, pneumococcal, and herpes zoster vaccines. Cancer screening for patients with HIV includes lifelong cervical cancer screening. Anal cancer screening should start at age 35 for men who have sex with men and transgender women, and at age 45 for all other patients. Family physicians are uniquely positioned to deliver comprehensive care that addresses HIV-specific needs and whole person primary care.