Reducing HIV-1 transmission through prevention strategies targeting HIV-1-seropositive individuals.
Prevention efforts for HIV-1 have traditionally focused on those at risk for acquiring the virus. Recently, there has been growing interest in directing prevention efforts towards HIV-1-seropositive individuals, who are seeking care in increasing numbers as a result of improving access to antiretroviral therapy in resource-limited countries. Biomedical interventions aimed at reducing the spread of HIV-1 by targeting those at risk for transmitting the virus will be guided in part by an understanding of the bidirectional interactions between HIV-1 and other sexually transmitted diseases (STDs). Among those who are infected with HIV-1, STDs are common, and immunosuppression may further increase STD risk. In turn, the presence of an STD increases the concentration of HIV-1 in genital mucosal secretions. Both antiretroviral therapy and treatment of STDs can lower genital HIV-1 concentrations, suggesting that these approaches may reduce infectivity. Thus, the growing availability of HIV-1 and STD treatment in the countries most affected by the HIV-1 epidemic provides a unique and important opportunity to develop prevention strategies that target HIV-1/STD interactions at multiple levels. Further work is urgently needed to develop, test and implement comprehensive strategies for prevention in positives.
McClelland
R Scott
RS
Department of Medicine, University of Washington, Seattle, WA, USA. mcclell@africaonline.co.ke
Baeten
Jared M
JM
D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006679:HIV Seropositivity / Q000628:therapy*; D015497:HIV-1; D006558:Herpes Genitalis / Q000453:epidemiology / Q000517:prevention & control; D018258:Herpesvirus 2, Human; D006801:Humans; D011634:Public Health; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control