title: Antiretroviral therapy to reduce the sexual transmission of HIV.
abstract: Sexual transmission of HIV is the principal mode of spread of HIV throughout the world. Whether the use of combination antiretroviral therapy will affect the sexual transmission of HIV remains to be seen. For an effect to occur, the viral load reductions seen within the blood need to be mirrored at a mucosal level, within the rectal tissues, the female genital tract and the semen of HIV-1-infected men. In part, this will be determined by the local concentrations of drugs within the genital tract. In this overview, we summarise the current knowledge on antiretroviral drug penetration into the male and female genital tracts. We also review studies that have investigated the effect of antiretroviral therapy on genital-tract shedding. The clinical implications of these studies are discussed. We conclude that the risk of HIV transmission exists as a spectrum, with many factors, both behavioural and biological, at interplay. It is conceivable that the use of antiretroviral therapy could reduce the spread of HIV from certain individuals. However, this idea is based on biological plausibility and surrogate marker data, rather than prospective population studies. In the worst-case scenario, antiretroviral therapy may simply increase the transmission of drug-resistant virus.
authors.affiliation: Department of Sexual Medicine, Brimingham Heartlands Hospital, Birmingham B9 5SS, UK. s.taylor.1@bham.ac.uk
authors.forename: Stephen
authors.initials: S
authors.lastname: Taylor
authors.forename: Marta
authors.initials: M
authors.lastname: Boffito
authors.forename: Pietro L
authors.initials: PL
authors.lastname: Vernazza
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002582:Cervix Mucus / Q000737:chemistry; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D005831:Genital Diseases, Female / Q000188:drug therapy / Q000821:virology*; D005832:Genital Diseases, Male / Q000188:drug therapy / Q000821:virology*; D006678:HIV / Q000254:growth & development*; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D008297:Male; D012661:Semen / Q000737:chemistry; D014018:Tissue Distribution / Q000187:drug effects; D017201:Virus Shedding / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents