Risk of transmission without Prophylactic treatment
Vaginal : 1:3000- 1:10,000 for insertive intercourse; 1:1000 for receptive intercourse
Oral sex : 1:1000 for receptive fellatio with ejaculation; unclear for insertive fellatio or cunnilingus
Needle stick injury: 1:300
Anal sex : 1:100 for receptive anal intercourse
Mother to child: 25%- 30% perinatal transmission without medication
Treatment
initiated when:
CD4 drops < 500 in an asymptomatic patient (definitely if < 350)
(or)
Viral load is very high (> 100,000)
(or)
Opportunistic infection occurs
The best initial regimen = emtricitabine + tenofovir + efavirenz (Atripla)