There are 40.8 million people around the world currently living with human immunodeficiency virus (HIV). In 2024, about 1.3 million people worldwide became infected with HIV. Although the number of people infected each year decreases, we still need to educate our patients on how they can protect themselves from getting HIV. Pharmacists can play a big role in HIV prevention as they are the most accessible healthcare professionals.

What is HIV?

There are about 1.2 million people in the United States who have HIV. HIV is a retrovirus that attacks the immune system. It is most commonly spread through sex or injection drug use. Symptoms of HIV include fever, swollen lymph nodes, and fatigue. Similar symptoms can occur with other diseases so it is important to get tested as soon as possible if you suspect you may have HIV.  HIV infection can lead to serious health issues such as a damaged immune system so it is important that we prevent it and try to diagnose it early if needed.

Non-Pharmacological Prevention Strategies

There are many ways that people can protect themselves from acquiring HIV. Prevention strategies often include using practicing safe sexual behaviors and safe injection practices.

Safe Sex Behaviors

• Using condoms
• Limiting your number of sexual partners
• Routinely getting tested for sexually transmitted infections (STIs)

Safe Injection Drug Use

• Use a new needle for each injection
• Never share needles
• Dispose of needles or other sharp materials properly to prevent accidental injuries

Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is used to help prevent HIV in those who are at a high risk of acquiring HIV. Some groups who are at a high risk of acquiring HIV include men who have sex with men (MSM), people who inject drugs, and those who routinely are sexually active with people who either have HIV or are unsure of their HIV status. However, PrEP may be used by anyone who may want to protect themselves from HIV. When taken as prescribed, PrEP reduces the risk of HIV transmission via sex by 99% and reduces risk with injection drug use by at least 74%.

Prior to beginning PrEP, patients will need to get tested for HIV. Once it is confirmed the patient is HIV negative, they are able to choose between oral and injectable PrEP.  Choosing which form of PrEP to use should depend on patient factors such as kidney function as well as adherence. If a patient is not adherent to their PrEP regimen, they are at risk for acquiring HIV.

Post-Exposure Prophylaxis (PEP)

Post-Exposure Prophylaxis (PEP) is used in patients who have knowingly, or think there is a chance they have, been exposed to HIV in the last 72 hours. There are two kinds of PEP, occupational and non-occupational. Occupational PEP is most often used in healthcare workers who have had a recent needle stick involving a patient with HIV or with unknown HIV status.

Non-occupational PEP is often used when someone has had unprotected sex with someone who is either HIV positive or is of unknown HIV status, when someone has shared a needle while using injectable drugs, or if someone has been sexually assaulted. PEP regimens are oral medications that need to be taken consistently for 28 days.

Potential PrEP Medications

Dapivirine vaginal rings are approved for PrEP use in patients assigned female at birth in some African countries. These rings allow for 1-month of HIV prevention without having to remember to take an oral medication every day. Dapivirine rings have been shown to reduce the risk of HIV between 35% and 50%. In a study done in Africa, adolescent girls and young women found that after trying both oral PrEP and dapivirine vaginal rings for PrEP, two-thirds of participants preferred the dapivirine vaginal ring. This showed that dapivirine rings can be an alternative option for PrEP for those who may have difficulty adhering to oral PrEP.  However, these rings only prevent against vaginal transmission of HIV whereas other PrEP medications provide systemic protection.

At this time dapivirine vaginal rings are not being considered for use in the United States, as there has yet to be studies comparing their efficacy against current approved PrEP options such as tenofovir and cabotegravir.

Another potential PrEP option is an efavirenz vaginal film. This dosage form is still in development as efavirenz has low aqueous solubility. However, a film made with polymers and polyvinyl alcohol has been shown to help aid in solubility. Vaginal films would be dissolved in the vagina prior to sex to help protect against HIV. This alternative dosage form could provide a PrEP option for those who may have issues accessing or adhering to currently available medications. This product has not been tested for safety or efficacy, but is an area for potential future study.

How Pharmacists Can Help Prevent HIV

Pharmacists can continue to educate patients on ways to prevent HIV, including safe sex practices and safe injectable drug use. Additionally, there are ways that pharmacists may be able to prescribe PrEP or PEP to their patients. One way is through a collaborative practice agreement (CPA) where a pharmacist has a formal agreement with a physician that allows them to provide care that is typically outside the scope of a pharmacist. Another way pharmacists can prescribe HIV prevention medications is through state legislation. Many states have specified protocols that pharmacists need to follow to prescribe HIV prevention medications. Often training on HIV prevention through continuing education (CE) courses or another specified training program is required to be able to prescribe these medications. You can visit NASTAD’s website to learn more about HIV prevention prescribing in each state. Pharmacists should be knowledgeable on general HIV prevention as well as their state’s rules and regulations on prescribing HIV PrEP and PEP to help patients reduce their risk of acquiring HIV.

Kailee G., APPE student

Sources:

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