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Standing at the crossroads in HIV management: implications for primary care practice from the AIDS 2014 conference

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Increase testing, increase treatment, consider prophylaxis, search for a cure and try to eradicate HIV

There has recently been renewed interest in HIV management in Australia. Studies have contributed evidence that effective HIV antiretroviral treatment (ART)1,2 and chemoprophylaxis3 prevent HIV transmission. There is a push to identify people with chronic HIV infection who have not been tested4 and to identify people during the acute phase of infection,5,6 when they are most infectious and most likely to transmit disease7 but unlikely to know they are infected.8 HIV treatment is more effective than it was previously; lower pill burdens cause fewer side effects and less toxicity and are less prone to the development of resistance. When combined with traditional HIV prevention measures, the use of antiretroviral agents as pre-exposure prophylaxis (PrEP) by HIV-negative people at high risk of HIV infection reduces transmission by about 75%. The World Health Organization recently recommended PrEP be integrated into prevention programs.9

The 20th International AIDS Conference was held in Melbourne…