HIV Treatment as Prevention: To be or not to be?

Published: October 1, 2010

Now 30 years after the first case of AIDS was described we have yet to develop reliable methods-either behavioral or biological-to prevent the spread of HIV. The spectacular and life-saving success of antiretroviral therapy has been more than offset by the challenge of treating millions of people world wide for their entire lives, and the sobering observation that for every person we treat several more become newly infected.1

Given this sad reality, no prevention stone should go unturned. And it seems more than reasonable to believe that antiretroviral drugs can be used for prevention.2 Indeed, these drugs have demonstrated the ability to nearly eliminate vertical (mother to baby) transmission of HIV,3 implementation challenges notwithstanding.

Antiretroviral agents could be used to prevent the sexual transmission of HIV as preexposure prophylaxis, postexposure prophylaxis or to reduce transmission from infected patients.2 The latter approach has great promise: because personal health can benefit from antiretroviral therapy (ART) why not exploit the public health benefit as well? Indeed, many drugs concentrate in the genital secretions leading to profound and prolonged (albeit incomplete) suppression of HIV in the genital tract.2

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