AIDS
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Multicenter Study
Preexposure prophylaxis for the prevention of HIV transmission to women.
The Food and Drug Administration (FDA) recently approved a new preexposure prophylaxis (PrEP) indication for emtricitabine/tenofovir for men and women, allowing a new effective HIV prevention intervention. Recent clinical trials have demonstrated the efficacy of PrEP in reducing the risk of HIV acquisition among women. Its efficacy depends largely on adherence. ⋯ HIV-uninfected women in serodiscordant couples seeking conception may prove to be an ideal population for PrEP. Periconceptional PrEP in highly motivated couples could be not only effective but also affordable and feasible. In order to make PrEP accessible to those populations most vulnerable to HIV infection, the following steps need to occur: PrEP needs to be affordable, particularly for those uninsured; HIV providers, primary care practitioners, and reproductive healthcare providers need to welcome PrEP as a component of their scope of practice; clinicians need to take adequate sexual histories of all their patients in order to identify those at risk and best candidates for PrEP; and identifying ways to promote adherence must include population-specific PrEP adherence interventions.
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To review the evidence for antiretroviral 'treatment as prevention' for HIV transmission among MSM. ⋯ The benefits of treatment as prevention for MSM are highly plausible, but not certain. In the face of these unknowns, treatment guidelines for earlier ART initiation should be considered within a combination prevention strategy that includes earlier diagnosis, expanded STI treatment, and structural and behavioral interventions.
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The apolipoprotein E (APOE) ε4 allele enhances cerebral accumulation of β-amyloid (Aβ) and is a major risk factor for sporadic Alzheimer's disease. We hypothesized that HIV-associated neurocognitive disorders (HAND) would be associated with the APOE ε4 genotype and cerebral Aβ deposition. ⋯ The APOE ε4 and older age increased the likelihood of cerebral Aβ plaque deposition in HIV-infected adults. Generally, Aβ plaques in HIV brains were immunohistologically different from those in symptomatic Alzheimer's disease brains. Nonetheless, Aβ plaques were associated with HAND among APOE ε4 carriers. The detection of APOE ε4 genotype and cerebral Aβ deposition biomarkers may be useful in identifying living HAND patients who could benefit from Aβ-targeted therapies.