• Having an undetectable viral load when on HIV treatment (ART) also stops HIV transmission
• For > 20 years it is known that ART reduces HIV transmission but now it is clear that the risk is not just reduced but stopped completely.
• ART protects your partners.
• You don’t need to use condoms if you were only using them to stop HIV provided you take ART every day and have undetectable viral load for at least three months and continue to take meds without missing doses.
• The evidence for U=U comes from studies with both gay and straight couples, and for all types of sex. 
• There should be no doubt that a person with sustained, undetectable levels of HIV in their blood cannot transmit HIV to their sexual partners.

HIV Single Tablet (2 for prevention and 3 for treatment)

1. Abacavir-lamivudine-dolutegravir
2. Elvitegravir-cobicistat-emtricitabine-tenofovir disoproxil fumarate,
3. Elvitegravir-cobicistat-emtricitabine-tenofovir alafenamide
4. Bictegravir-emtricitabine-tenofovir alafenamide
5. Nucleoside combination (tenofovir disoproxil fumarate-emtricitabine, tenofovir alafenamide-emtricitabine, or abacavir-lamivudine) be used with EITHER a boosted protease inhibitor (ritonavir-boosted lopinavir, ritonavir-boosted darunavir) OR an integrase strand transfer inhibitor (raltegravir, elvitegravir/cobicistat, dolutegravir, or bictegravir)
6. Cipla: Stavudine + Lamivudine + Nevirapine
7. Cipla: TLD (tenofovir (TDF), lamivudine (3TC) and dolutegravir (DTG).

Pre exposure prophylaxis:

Tenofovir disoproxil fumarate-emtricitabine should be taken daily [Truvada/TenvirEM 200 mg/300 mg Tablet: Emtricitabine (200mg) + Tenofovir disoproxil fumarate (300mg)]

Post exposure prophylaxis X 28 days: 

1. Viraday  or viropil: Emtricitabine (200 mg) + Tenofovir disoproxil fumarate (300 mg) + Efavirenz (600 mg)
2. Viropil: Dolutegravir (50 mg) + Lamivudine (300 mg) + Tenofovir disoproxil fumarate (300 mg)
3. Tenofovir disoproxil fumarate-emtricitabine plus one of the following: Raltegravir (Isentress) 400 mg twice daily or Dolutegravir (Instgra) 50 mg once daily

Take home points

• Treatment with three drugs in one pill, taken life long
• Pre exposure prophylaxis with two drugs taken daily
• Post exposure prophylaxis with 3 drugs taken for 28 days started within 3 days

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA