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New HIV Guidelines Released by WHO

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Guideline Recommendations continued...

"There is strong evidence for this recommendation," said guideline chair Chris Beyrer, MD. He's the director of the Johns Hopkins Center for Public Health and Human Rights in Baltimore, and president-elect of the International AIDS Society.

Beyrer stressed, though, that PrEP treatment is not recommended for all men who have sex with men -- only those who want the treatment and who are at risk for HIV. He explained that PrEP must be used with other prevention methods, such as condoms, condom-appropriate lubricant, and education.

The recommendation to consider PrEP an option for HIV prevention in men who have sex with men is both "valuable and important," said Robert Grant, MD, MPH. He's a professor of medicine at the University of California, San Francisco. Grant was involved in a study that showed that PrEP provides a high degree of protection against HIV infection, even if someone didn't take the medicine exactly as prescribed.

"I think the WHO recommendation reflects the high-quality evidence that PrEP provides protection for men who have sex with men," Grant said.

He cautioned, though, that people do go through "seasons of risk," and they might stop treatment if they no longer feel they need PrEP for HIV protection.

The other major recommendation is to make the medication naloxone available in the community to reverse an overdose. People likely to witness an opioid overdose should have access to naloxone and be taught how to use it in case of an emergency, the guidelines say.

Overdose Deaths and HIV

"We know that, worldwide, 69,000 individuals die from heroin or opioid overdose each year," said Phillip Read, MD. He's the medical unit manager at the Kirketon Road Centre in Sydney, Australia. "In fact, HIV-positive people who inject [opioids] and who are on treatment have a greater risk of dying from an overdose than from HIV." Also, about 60% of overdose deaths occur in the presence of someone else.

Naloxone rapidly reverses the toxic effects of heroin and some opioids, such as oxycodone. It can be given by injections or sprayed directly into the nostrils in aerosol form. 

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