Even though new diagnoses are declining, in the U.S. there were about 36,000 new HIV diagnoses made in 2021 [2]. Over one million people in the U.S. are living with HIV and about one in eight people with HIV don't know they have it [2]. Sexual transmission is most common, especially in men who have sex with men (~67%) [2]. Heterosexual contact makes up about 22% of HIV transmission [2]. Injection drug use accounts for about 7% of HIV transmission [2]. Besides differences in the mode of HIV transmission, the epidemiology of HIV is also impacted by race or ethnicity. Black people make up the largest proportion of new HIV diagnoses, followed by Hispanics/Latinos, followed by white people [2]. Finally, there are differences based on geography. For the most part, HIV is diagnosed more frequently in the South and less frequently in the North. For example, in 2020 the largest rates of HIV diagnoses in the U.S. occurred in Florida, Georgia, and Louisiana [3].

Even though new diagnoses are declining, in the U.S. there were about 36,000 new HIV diagnoses made in 2021 [2]. Over one million people in the U.S. are living with HIV and about one in eight people with HIV don't know they have it [2]. Sexual transmission is most common, especially in men who have sex with men (~67%) [2]. Heterosexual contact makes up about 22% of HIV transmission [2]. Injection drug use accounts for about 7% of HIV transmission [2]. Besides differences in the mode of HIV transmission, the epidemiology of HIV is also impacted by race or ethnicity. Black people make up the largest proportion of new HIV diagnoses, followed by Hispanics/Latinos, followed by white people [2]. Finally, there are differences based on geography. For the most part, HIV is diagnosed more frequently in the South and less frequently in the North. For example, in 2020 the largest rates of HIV diagnoses in the U.S. occurred in Florida, Georgia, and Louisiana [3].

HIV can be passed from person to person in a variety of ways. It is important to be aware that HIV is NOT transmitted by [4]:

HIV can be present in certain body fluids, such as blood, semen, pre-seminal fluid, rectal and vaginal fluids, and breast milk. Transmission is possible when these fluids contain HIV and come into contact with mucous membranes (rectum, vagina, penis, mouth), damaged tissues or skin, or are injected into the bloodstream [4].

The Centers for Disease Control and Prevention (CDC) recommends at least one HIV screening for all people ages 13 to 64 years old unless the patient refuses testing (opt-out screening) upon being informed that testing for HIV is routine. Screening should be offered at least yearly for patients with risk factors for HIV, such as men who have sex with men, patients with multiple sexual partners, etc. Similarly, CDC also recommends HIV screening with each pregnancy, unless the patient opts out after notification that testing for HIV is routine [12].

Condoms are considered highly effective if used correctly and consistently [17]. It's recommended to use lubricants with condoms, to prevent them from breaking. Male latex condoms should only be lubricated with water- or silicone-based lubricants; they should not be lubricated with oil-based products. For instance, patients should not use Vaseline, mineral oil, shortening, or other vegetable oils as lubricants when using latex condoms. Oil-based lubricants can weaken the latex membrane and cause it to break. On the other hand, any type of lubricant can be used with nitrile female condoms [17].

Per OSHA, employers must provide a safe work environment. OSHA requires that employees who could come into contact with materials that may have HIV wear personal protective equipment, such as gloves, gowns, masks, and goggles; wash their hands with soap before and after putting on gloves; and dispose of needles and other sharps properly in a sharps container. To prevent needle sticks, avoid bending or recapping needles or use needleless devices [25]. These strategies are known as "universal precautions." Be sure to always follow your company's policies and training requirements around bloodborne pathogens and infection control.

After someone is potentially exposed to HIV, postexposure prophylaxis (also called PEP, nPEP [nonoccupational PEP], oPEP [occupational PEP]) can be used to reduce the risk of developing HIV. PEP is different than PrEP. PEP is only used in emergency situations. It is to be taken for a short period of time (28 days) after a possible exposure to HIV, and unlike PrEP, is not to be taken long-term. PEP is not 100% effective. However, to maximize the benefit, quick access to PEP is very important. PEP needs to be started as soon as possible, usually no later than 72 hours after a possible exposure [35; 36; 37].

Opportunistic infections can be caused by viruses, bacteria, fungi, and parasites. Many opportunistic infections (certain forms of pneumonia, tuberculosis [TB], etc.) are considered AIDS-defining conditions and are included in the CDC's list of diagnostic criteria for AIDS [43]. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV [44].

CDC considers the following illnesses to be AIDS-defining conditions [45]:

Examples of PIs include:

Most initial regimens for someone who has never been treated with ART (i.e., "treatment naive") will contain two NRTIs combined with a third medication from one of three drug classes: INSTI, NNRTI, or PI with a booster (cobicistat or ritonavir). There is also one two-drug regimen (dolutegravir plus lamivudine) that may be recommended as a first-line option for initial therapy in some patients with HIV.

In general, INSTI-based regimens are preferred because they are highly effective, well tolerated, and have fewer drug interactions compared to PI-based regimens. However, patients with a history of having received the cabotegravir long-acting injectable for PrEP will require INSTI genotypic resistance testing before initiating INSTI therapy. This is because drug levels of long-acting cabotegravir may be present in some individuals for up to four years, and this persistent suboptimal drug exposure may select for INSTI-resistant virus [53].

Expect to see one of the following recommended combinations as initial therapy for treatment-naive patients [53]: