Highly active antiretroviral treatment for the prevention of HIV transmission

Abstract

In 2007 an estimated 33 million people were living with HIV; 67% resided in sub-Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV-positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in need of HAART and 2.7 million more became infected with HIV.Although there has been unprecedented investment in confronting HIV/AIDS - the Joint United Nations Programme on HIV/AIDS estimates $13.8 billion was spent in 2008 - a key challenge is how to address the HIV/AIDS epidemic given limited and potentially shrinking resources. Economic disparities may further exacerbate human rights issues and widen the increasingly divergent approaches to HIV prevention, care and treatment.HIV transmission only occurs from people with HIV, and viral load is the single greatest risk factor for all modes of transmission. HAART can lower viral load to nearly undetectable levels. Prevention of mother to child transmission offers proof of the concept of HAART interrupting transmission, and observational studies and previous modelling work support using HAART for prevention. Although knowing one's HIV status is key for prevention efforts, it is not known with certainty when to start HAART.Building on previous modelling work, we used an HIV/AIDS epidemic of South African intensity to explore the impact of testing all adults annually and starting persons on HAART immediately after they are diagnosed as HIV positive. This theoretical strategy would reduce annual HIV incidence and mortality to less than one case per 1000 people within 10 years and it would reduce the prevalence of HIV to less than 1% within 50 years. To explore HAART as a prevention strategy, we recommend further discussions to explore human rights and ethical considerations, clarify research priorities and review feasibility and acceptability issues.

Keeping Them in “STYLE”: Finding, Linking, and Retaining Young HIV-Positive Black and Latino Men Who Have Sex with Men in Care

“…54 National data highlight the need to link MSM of color and other HIV-infected populations to care to improve their overall health and to stem further infections. [55][56][57][58] The DHHS HIV guidelines now recommend earlier initiation of ART to prevent long-term complications and preserve immune function. 25,[59][60][61] In our study, youth achieved viral suppression rates greater than 75%, which compares favorably to levels of virologic success ranging from 51% to 79% for currently utilized NNRTI, or boosted PI regimens in adult cohorts.…”

Behavioral and Biomedical Combination Strategies for HIV Prevention

“…ART can reduce the plasma and genital HIV viral load in the infected individual to undetectable levels (Granich et al 2010). In a study of 415 HIV serodiscordant couples in Uganda, 21.7% of the initially uninfected partners became infected over 30 months of follow-up, translating to a transmission rate of approximately 12 infections per 100 person years (Fig.…”

AIDS Vaccines and Preexposure Prophylaxis: Is Synergy Possible?

“…46 Observational studies and recent modeling work have triggered considerable interest and concerns regarding the use of ART in HIV-infected individuals to prevent secondary transmission. 32,[47][48][49][50][51][52][53][54] In the coming years, systemic PrEP or drug-based microbicides (which in this discussion is considered a topical form of PrEP) may be proven to safely confer protection against HIV infection. In that instance, even though the implementation of a ''background'' intervention would require careful consideration by national governments, 55 PrEP might be proposed as a baseline intervention for AIDS vaccine trial participants.…”