HIV anti-retroviral drugs:

Truvada (emtricitabine/tenofovir disoproxil fumarate) has recently been approved by the FDA for prevention of HIV. It is a fixed dose of two anti-retroviral drugs and marketed by Gilead Sciences.

Targetting HIV entry co-receptors: Other possibilities which are being explored is to target CCR5 and CXCR5 which serve as co-receptors for HIV entry. Michael Farzan, for example, has led a team of scientists at the Scripts Research Institute in Jupiter Florida to design a protein which mimics CCR5 and prevents the HIV virus from entering the cell.

An array of small molecule inhibitors that prevent HIV entry into cells have been developed, which many in clinical trails and one having been licensed in 2003.

Microbicides: 

Potential microbicides for HIV can be placed into one of three categories:

(1) compounds that inhibit virus infection nonspecifically. Most microbicide candidates tested to date fall within this category. The first candidate microbicide for HIV to reach phase III clinical trails was the spermicidal detergent nonxynol-9. Although the compound inactivates HIV in vitro by disrupting the outer viral membrane, it failed to prevent sexual transmission of the virus in vivo. In fact, women who used nonoxyl-9 containing gels had a higher rate of infection by HIV, most likely because the detergent disrupted the membranes of the epithelial cells in the genital tract which otherwise serve as an important barrier to virus infection. (Davis et al 2004).

(2) compounds that specifically target the virus. Passive administration of neutralizing antibodies can convert sterilizing immunity to macaques who are vaginally challenged with virus, provided the antibodies are present within several hours of virus application. Likewise, a vaginally applied neutralizing antibody prevented infection of macaques. Although promising, the greatest drawbacks to the use of moncolonal antibodies is their cost and the structural variability of the viral Env protein to which they bind. Only a handful of broadly cross-reactive, neutralizing a

ntibodies have been developed over the past 20 yr and none of these recognize all virus strains.

Recently, small molecule inhibitors that prevent HIV entry into cells have been developed with many in clinical trials and one licensed in 2003. Since viral attachment to and entry into host cells is the first step in establishing an infection, this process is particularly attractive target for microbicides. However, there are multiple ways by which HIV can infect target cells i n the genital mucosa. . Second, even if all host receptors for viral entry are blocked, HIV may be capable of evading these inhibitors by hitching a ride on DCs.

Decontamination: 

Low pH has been reported to inactivate HIV. For example, dilute acetic acid (pH 2.8) (white vinegar; Heinz Inc.) has been reported to inactivate HIV (Martin et al., Disinfection and inactivation of the human T lymphotropic virus type III/lymphadenopathy-associated virus. J. Infect. Dis. 152:400-403 1985).

Pre-exposure Prophylaxis (PrEP):

PrEP is recommended by the CDC if one has had anal or vacinal sex in the past 6 months and condoms have not been used every time, or one partner has HIV, you were diagnosed with an STD in the past 6 months or you are a woman with and HIV positive partner who is trying to get pregnant.

Daily PrEP with Descovy and Truvada is a pill one takes every day. PrEP also comes as a long acting injection called Apretude that one gets form a doctor every 2 months.

If one does not have sex very often, you can use on-demand PrEP ills. For this regimen, you take: 1. two pills 2-24 hours before you have sex, 2. one pill 24 hours after the first dose and 3. one pill 24 hours after the second dose.

As of January 2019, the FDA has approved three medications as PrEP for HIV: (1) Truvada (tenofovir disproxil fumarate 200 mg/emtricitabine 200 mg) (NYS Clinical Guideliens identify Truvada as a preferred oral regimen for daily or on demand dosing) (2) Descovy (tenofovir alafenamide 25 mg/emtricitabine 200 mg) (NYS Clinical Guidelines identify Descovy as an alternative oral regimen used only in daily dosig for cisgender MSM and transgender women –Descovy is not approved for use by cis-gender women and is not for use during pregnancy) and (3) Apretude (Long-acting injectable cabotegravir 600 mg). (NYS Clincal Guidlines identify Apretude as a preferred regimen. but is generally not an option during preganncy. Not all clinical settings are prepared to adminsiter long-acting inectable PrEP).

Daily PrEP: Daily PrEP invovles people of any gender idneeity taking 1 pill once a day, every day. With daily PrEP a perosn can feel protected form HIV whenever they have sex or inject substances.

On-Demand PrEP: is only for cis-gender men who have sex with men (MSM). On-demand PrEP invovles taking 2 pills, 2-24 hours before a possible sexual exposure to HIV and then continuing to take 1 pill each day until 2 days after their last possible sexual exposure. The only PrEP medication approved for on-demand use is Truvada.

Long-Acting Injectable PrEP: is taken by injection by anone who is eligible for PrEP who weights at least 77 pounds.

PEP:

One has to take PrEP consistenlty for it to protect you from HIV. Post-exposure prophylaxis, or PEP, is the pill one takes after having unprotected sex. When you take PEP within 72 hours of a possible exposure, it is very effective at preventing HIV. But PEP is only for emergencies and not as a substitute of PrEP.