title: HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel.
abstract: OBJECTIVE
  Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings.
  
  
  OBJECTIVE
  To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings.
  
  
  METHODS
  Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus.
  
  
  RESULTS
  Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible.
  
  
  CONCLUSIONS
  Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
authors.affiliation: University of Washington, Seattle.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Marrazzo
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
authors.affiliation: University of North Carolina at Chapel Hill.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: University of Connecticut, Storrs.
authors.forename: Seth C
authors.initials: SC
authors.lastname: Kalichman
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: University of British Columbia, Vancouver.
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: Loyola University Chicago, Chicago, Illinois.
authors.forename: Darrell P
authors.initials: DP
authors.lastname: Wheeler
authors.affiliation: University of California San Francisco.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Grant
authors.affiliation: Evandro Chagas Clinical Research Institute (IPEC)-FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: University of California Los Angeles.
authors.forename: Steven
authors.initials: S
authors.lastname: Shoptaw
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.affiliation: Université de Bordeaux, Bordeaux, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.affiliation: The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sugarman
authors.affiliation: University of California San Diego.
authors.forename: Constance A
authors.initials: CA
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D015497:HIV-1; D040261:Harm Reduction; D006801:Humans; D008297:Male; D056990:Post-Exposure Prophylaxis; D012306:Risk; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control
chemical_list: D044966:Anti-Retroviral Agents